Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pediatrics, Tobu Chiiki Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan.
Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Allergol Int. 2024 Oct;73(4):556-562. doi: 10.1016/j.alit.2024.05.001. Epub 2024 May 15.
Food protein-induced enterocolitis syndrome caused by solid foods (Solid-FPIES) is a non-immunoglobulin E-mediated allergic disease characterized by delayed gastrointestinal symptoms. An oral food challenge (OFC) test, although necessary, can be inconclusive in cases with mild symptoms. Moreover, limited diagnostic marker availability highlights the need for novel surrogate markers. We aimed to examine the efficacy of fecal hemoglobin (FHb), lactoferrin (FLf), and calprotectin (FCp) over time in evaluating gastrointestinal inflammation degree in Solid-FPIES.
This observational study included 40 patients and 42 episodes at Juntendo University Hospital and affiliated hospitals between October 2020 and March 2024 categorized into FPIES (12 patients with 11 egg yolk, 1 fish, and 1 soybean episodes), control (14 patients with 15 episodes), and remission (14 patients). Fecal tests were performed for 7 days following antigen exposure. The ratios of each value were divided by the baseline value and analyzed over time course.
The FPIES group had significantly higher peak ratios of all fecal markers than the control group (p < 0.01). The median FHb, FLf, and FCp ratios were 3.25, 9.09, and 9.79 in the FPIES group and 1.08, 1.29, and 1.49 in the control group, respectively. In the remission group, several patients had fluctuating fecal markers despite negative OFC, and one patient was diagnosed with FPIES by OFC with increased load. Receiver operating characteristic curve analyses revealed high diagnostic performance for each fecal marker in FPIES.
Sequential fecal marker examination proved valuable in diagnosing Solid-FPIES and evaluating the degree of gastrointestinal inflammation.
由固体食物引起的食物蛋白诱导的小肠结肠炎综合征（Solid-FPIES）是一种非免疫球蛋白 E 介导的过敏疾病，其特征为延迟性胃肠道症状。口服食物激发试验（OFC）虽然是必要的，但在症状较轻的情况下可能无法得出明确结论。此外，有限的诊断标志物可用性凸显了对新型替代标志物的需求。我们旨在研究粪便血红蛋白（FHb）、乳铁蛋白（FLf）和钙卫蛋白（FCp）随时间推移在评估 Solid-FPIES 胃肠道炎症程度方面的效果。
这项观察性研究纳入了 2020 年 10 月至 2024 年 3 月期间在顺天堂大学医院及其附属医院就诊的 40 名患者和 42 个发作期，分为 FPIES（12 名患者，11 例蛋黄、1 例鱼和 1 例大豆）、对照组（14 名患者，15 例）和缓解组（14 名患者）。在抗原暴露后进行 7 天粪便检测。将各值的比值除以基线值，并进行时间过程分析。
FPIES 组的所有粪便标志物的峰值比值均显著高于对照组（p<0.01）。FPIES 组的 FHb、FLf 和 FCp 比值中位数分别为 3.25、9.09 和 9.79，对照组分别为 1.08、1.29 和 1.49。在缓解组中，尽管 OFC 结果为阴性，但一些患者的粪便标志物仍存在波动，1 名患者因 OFC 负荷增加而被诊断为 FPIES。受试者工作特征曲线分析显示，每种粪便标志物在 FPIES 中均具有较高的诊断性能。
连续的粪便标志物检测对诊断 Solid-FPIES 和评估胃肠道炎症程度具有重要价值。
