Shinohara Miwa S, Nino Ryuji, Higaki Takashi, Ishii Eiichi
Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, USA.
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, JPN.
Cureus. 2021 Aug 13;13(8):e17141. doi: 10.7759/cureus.17141. eCollection 2021 Aug.
An 11-month-old Japanese girl was diagnosed with food protein-induced enterocolitis syndrome (FPIES) after presenting with vomiting approximately two hours after wheat intake. She showed positive results on the first wheat oral food challenge (OFC) at nine months of age, although serum wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) were not detected. The second wheat OFC, performed at age 13 months, induced wheezing (usually an IgE-mediated symptom) 4.5 hours after ingestion, probably owing to gastroesophageal reflux caused by repetitive vomiting. The third wheat OFC, performed at age 25 months, did not trigger reactions. Therefore, gradual low-dose wheat was reintroduced at home. The fourth wheat OFC performed at age 30 months induced no response either; thus, the patient was deemed to have developed tolerance to wheat. This case report, therefore, demonstrates that careful assessment of natural history and physician-supervised OFCs are necessary for adequate diagnosis and the successful management of reintroduction in wheat-induced FPIES.
一名11个月大的日本女孩在摄入小麦后约两小时出现呕吐症状，随后被诊断为食物蛋白诱导的小肠结肠炎综合征（FPIES）。她在9个月大时首次进行小麦口服食物激发试验（OFC）呈阳性结果，尽管未检测到血清小麦和ω-5麦醇溶蛋白特异性免疫球蛋白E（IgE）。13个月大时进行的第二次小麦OFC在摄入后4.5小时诱发了喘息（通常是IgE介导的症状），这可能是由于反复呕吐导致的胃食管反流。25个月大时进行的第三次小麦OFC未引发反应。因此，在家中逐渐重新引入低剂量小麦。30个月大时进行的第四次小麦OFC也未引起反应；因此，该患者被认为已对小麦产生耐受。因此，本病例报告表明，对自然病程进行仔细评估以及在医生监督下进行OFC对于小麦诱导的FPIES的准确诊断和成功重新引入管理是必要的。
