Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Pediatrics, Saitama Red Cross Hospital, Saitama, Japan.
Int Arch Allergy Immunol. 2022;183(9):975-979. doi: 10.1159/000524090. Epub 2022 Apr 7.
Several recent studies have reported egg yolk-associated food protein-induced enterocolitis syndrome (FPIES) in Japan. We previously reported the usefulness of post-emetic thymus and activation-regulated chemokine (TARC) levels for the diagnosis and evaluation of symptom severity in FPIES caused by solid foods including egg yolk. However, there are no studies on the usefulness of TARC as a prognostic biomarker.
The aim of the study was to evaluate the post-emetic TARC levels, clinical symptoms, and post-index event results of the egg yolk oral food challenge test (OFC), and retrospectively investigate predictive factors of the subsequent OFC result.
This retrospective study included 12 patients with egg yolk FPIES. The following long-term management protocol for egg yolk FPIES was mandatory for study inclusion: Patients visited the emergency department, met the diagnostic criteria of FPIES, and underwent an egg yolk OFC 6-12 months after complete elimination of egg yolk. If the result of the OFC was positive, the patient underwent the OFC every year until it was negative. We analyzed a total of 20 episodes (12 department visits and eight positive OFCs). The blood test data, including post-emetic TARC level and symptom severity, were compared between the next-OFC-positive group and the next-OFC-negative group. In addition, tolerance development over follow-up was analyzed.
The median (range) ages of the next-OFC-positive and negative groups were 11 (6-33) and 10 (7-21) months, respectively. The median (range) serum TARC (pg/mL) level was 5,208 (2,009-8,147) in the next-OFC-positive group, which was significantly higher (p = 0.004) than that in the next-OFC-negative group, which was 1,803 (905-3,754). There were no significant differences in other hematological results. The next-OFC-positive group had greater severity compared to the next-OFC-negative group (p = 0.026). The remission rate was approximately 30% at 24 months and 80% at 36 months.
Post-emetic TARC levels may predict the short-term prognosis of egg yolk FPIES after approximately 1 year and could be useful for the management of egg yolk FPIES.
最近有几项研究报告了日本与蛋黄相关的食物蛋白诱导性肠病综合征（FPIES）。我们之前报告了在蛋黄等固体食物引起的 FPIES 中，呕吐后胸腺和激活调节趋化因子（TARC）水平对诊断和评估症状严重程度的有用性。然而，尚无关于 TARC 作为预后生物标志物的研究。
本研究旨在评估呕吐后 TARC 水平、临床症状以及蛋黄口服食物挑战试验（OFC）后的指标事件结果，并回顾性研究预测后续 OFC 结果的因素。
本回顾性研究纳入了 12 例蛋黄 FPIES 患者。入组必须满足以下蛋黄 FPIES 的长期管理方案：患者就诊于急诊科，符合 FPIES 的诊断标准，并在完全消除蛋黄后 6-12 个月进行蛋黄 OFC。如果 OFC 结果阳性，则患者每年进行一次 OFC，直到结果阴性。我们共分析了 20 个发作（12 次就诊和 8 次阳性 OFC）。比较了下一次-OFC 阳性组和下一次-OFC 阴性组之间的呕吐后 TARC 水平和症状严重程度等血液检测数据。此外，还分析了随访期间的耐受发展情况。
下一次-OFC 阳性组和阴性组的中位（范围）年龄分别为 11（6-33）和 10（7-21）个月。下一次-OFC 阳性组的中位（范围）血清 TARC（pg/mL）水平为 5208（2009-8147），显著高于下一次-OFC 阴性组的 1803（905-3754）（p=0.004）。其他血液学结果无显著差异。与下一次-OFC 阴性组相比，下一次-OFC 阳性组的严重程度更高（p=0.026）。24 个月时的缓解率约为 30%，36 个月时的缓解率约为 80%。
呕吐后 TARC 水平可能预测蛋黄 FPIES 约 1 年后的短期预后，对蛋黄 FPIES 的管理可能有用。
