Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Division of Allergy, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Keio J Med. 2022 Sep 25;71(3):68-70. doi: 10.2302/kjm.2021-0016-CR. Epub 2022 Mar 5.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy characterized by repetitive vomiting within 1-4 h and/or diarrhea within 24 h after ingesting the causative food. We herein report a rare Japanese case of rice-induced FPIES. A six-month-old, female, Japanese patient presented to the emergency room (ER) with the complaint of vomiting after feeding. Postprandial vomiting had occurred occasionally since she started ingesting solid food at the age of 5 months. Rice-induced FPIES was suspected only after the fourth ER visit based on the characteristic history of recurrent vomiting occurring 1-2 h after ingesting food containing rice. Allergen-specific IgE testing and a skin prick test with an allergen scratch extract were both negative for rice. During an oral food challenge test (OFC), vomiting was observed after the patient ingested 2 g of rice porridge. Based on the OFC results and the entire clinical course, FPIES due to rice was diagnosed. A lymphocyte stimulation test with rice revealed a significantly elevated stimulation index. Rice-induced FPIES is rarely reported among Japanese infants despite rice being a staple in the Japanese diet. The prevalence of rice-induced FPIES differs greatly among populations, suggesting a multifactorial cause associated with its development. Delays in diagnosis are common in FPIES, and our case demonstrates the importance of obtaining a dietary history of food ingested prior to symptom onset in cases of infantile repetitive vomiting.
食物蛋白诱导的肠炎综合征（FPIES）是一种非 IgE 介导的胃肠道食物过敏，其特征是在摄入致病食物后 1-4 小时内反复呕吐和/或 24 小时内腹泻。本文报告了一例罕见的日本大米诱导 FPIES 病例。一名 6 月龄女性日本患者因喂食后呕吐就诊于急诊科（ER）。自 5 月龄开始摄入固体食物以来，她偶尔会出现餐后呕吐。在第四次 ER 就诊后，根据进食含大米食物后 1-2 小时反复呕吐的特征性病史，怀疑为大米诱导 FPIES。过敏原特异性 IgE 检测和过敏原划痕提取物的皮肤点刺试验均对大米呈阴性。在口服食物激发试验（OFC）中，患者摄入 2g 大米粥后出现呕吐。根据 OFC 结果和整个临床过程，诊断为大米引起的 FPIES。用大米进行的淋巴细胞刺激试验显示刺激指数明显升高。尽管大米是日本饮食的主食，但日本婴儿中很少报告大米诱导 FPIES。大米诱导 FPIES 在不同人群中的患病率差异很大，提示其发病与多种因素有关。FPIES 的诊断常常延迟，我们的病例表明，在婴儿反复呕吐的情况下，在症状出现前获取摄入食物的饮食史非常重要。
