Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
Curr Allergy Asthma Rep. 2022 Oct;22(10):113-122. doi: 10.1007/s11882-022-01037-y. Epub 2022 May 6.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown.
FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
食物蛋白诱导的小肠结肠炎综合征（FPIES）是一种非 IgE 介导的食物过敏，其特征为迟发性和潜在严重的胃肠道症状。自从确立了特定的诊断编码和诊断指南以来，我们对这种疾病的认识不断加深。
FPIES 可影响婴儿期到成年期的患者。任何食物都可能成为诱因，常见的罪魁祸首食物因地域和年龄而异。尽管研究表明全白细胞激活、细胞因子释放和胃肠道通透性增加，但对其复杂的潜在免疫机制仍难以捉摸。管理包括避免触发因素，患者可能受益于营养师的支持，以确保充足的营养摄入。大多数儿童随着时间的推移会产生耐受性，但由于严重症状的风险，仅建议在口服食物挑战下，由监督人员重新引入疑似 FPIES 触发因素。研究仍在继续评估最佳挑战方案。FPIES 患儿的照顾者报告存在高水平的焦虑和压力，这归因于症状的急剧性、饮食限制、营养问题、缺乏确证性诊断测试以及反应管理工具的有限性。在过去几十年中，我们对 FPIES 诊断的理解有所提高，但仍有机会，特别是在确定病理生理学和最佳管理实践方面。
