Department of Allergology and Pulmonology, Penteli's Children's Hospital, Athens, Greece;
Department of Pediatrics, Penteli's Children's Hospital, Athens, Greece.
Allergol Immunopathol (Madr). 2021 May 1;49(3):73-82. doi: 10.15586/aei.v49i3.79. eCollection 2021.
Food Protein-Induced Enterocolitis Syndrome (FPIES) is a clinically well-characterised, non-Immunoglobulin E (IgE)-mediated food allergy syndrome, yet its rare atypical presentation remains poorly understood.
Aim of this study was to present the 10-year experience of a referral centre highlighting the atypical FPIES cases and their long-term outcome.
FPIES cases were prospectively evaluated longitudinally in respect of food outgrowth and developing other allergic diseases with or without concomitant IgE sensitisation.
One hundred subjects out of a total of 14,188 referrals (0.7%) were identified. At presentation, 15 patients were found sensitised to the offending food. Fish was the most frequent eliciting food, followed by cow's milk and egg. Tolerance acquisition was earlier for cow's milk, followed by egg and fish, while found not to be protracted in atypical cases. Resolution was not achieved in half of the fish subjects during the 10-year follow-up time. Sensitisation to food was not related to infantile eczema or culprit food, but was related to sensitisation to aeroallergens. In the long-term evaluation, persistence of the FPIES or aeroallergen sensitisation was significantly associated with an increased hazard risk of developing early asthma symptoms.
Sensitisation to food was related neither to eczema or culprit food nor to tolerance acquisition but rather to the development of allergic asthma through aeroallergen sensitisation. In addition to an IgE profile at an early age, FPIES persistence may also trigger mechanisms switching FPIES cases to a T-helper 2 cells immune response later in life, predisposing to atopic respiratory symptoms; albeit further research is required.
食物蛋白诱导的肠病综合征（FPIES）是一种临床特征明确的非免疫球蛋白 E（IgE）介导的食物过敏综合征，但它罕见的非典型表现仍知之甚少。
本研究旨在介绍一个转诊中心 10 年来的经验，重点介绍不典型 FPIES 病例及其长期结果。
前瞻性评估 FPIES 病例在食物过敏和发展其他过敏性疾病方面的长期结果，包括 IgE 致敏和不伴有 IgE 致敏的情况。
在总共 14188 例转诊患者中，发现 100 例患者患有 FPIES（0.7%）。在就诊时，发现 15 例患者对致病食物过敏。最常见的诱发食物是鱼类，其次是牛奶和鸡蛋。牛奶的耐受获得较早，其次是鸡蛋和鱼类，而在不典型病例中发现不耐受不会延长。在 10 年的随访期间，一半的鱼类患者未能达到缓解。食物过敏与婴儿湿疹或致敏食物无关，而是与对气传过敏原的致敏有关。在长期评估中，FPIES 或气传过敏原致敏的持续存在与早期哮喘症状发生的风险增加显著相关。
食物致敏既与湿疹或致敏食物无关，也与耐受获得无关，而是与通过气传过敏原致敏发展为过敏性哮喘有关。除了早期 IgE 谱外，FPIES 的持续存在也可能引发机制转换，使 FPIES 病例在以后的生活中转变为 T 辅助 2 细胞免疫反应，易患特应性呼吸道症状；尽管需要进一步研究。
