İskender Nagihan, Uluç Nefise Nezihe, Ozanli Ismail, Ipekci Belkis, Akın Taha Yasin, Cogurlu Mujde Tuba, Uncuoğlu Aysen, Aksu Nihal Uyar, Balcı Sibel, Simsek Isıl Eser, Aydoğan Metin
Division of Pediatric Allergy and Immunology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
Division of Pediatric Allergy and Immunology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
J Allergy Clin Immunol Pract. 2025 Sep;13(9):2429-2436.e1. doi: 10.1016/j.jaip.2025.06.010. Epub 2025 Jun 16.
For food protein-induced allergic proctocolitis (FPIAP), published information on the time until tolerance for each causal food and their combinations remains scarce.
To determine time until tolerance for individual causal foods, causal foods in combination, and factors affecting tolerance development.
Of the 91 patients diagnosed with FPIAP between March 2019 and March 2020, 84 patients with at least 3 years of follow-up were evaluated in this prospective cohort.
The median age of the patients was 50 months at last evaluation (interquartile range [IQR]: 47-54 months), and 52.4% were male. The tolerance development rate was 36.6% in the first year, 88.9% in the second year, 96.4% in the third year, and 97.6% after the age of 3 years. The overall median tolerance development time was 15.5 (IQR: 12-22.5) months. For each causal food, cow's milk (CM), beef, wheat, eggs, and nuts, median times until tolerance were 13 (IQR: 12-18), 13 (IQR: 12-18), 14 (IQR: 10.7-16), 16 (IQR: 12-24), and 24 (IQR: 22.5-36.5) months, respectively. In multiple food allergies (MFA), the presence of eggs significantly prolonged the time until tolerance, whereas the presence of beef did not. Multivariate regression analysis revealed that MFA presence (odds ratio [OR]: 12.11, 95% confidence interval [CI]: 1.23-118.12, P = .03), atopic dermatitis (AD) at onset (OR: 4.04, 95% CI: 1.15-14.25, P = .03), and the absence of a pet at home (OR: 0.23, 95% CI: 0.06-0.87, P = .03) were associated with delayed tolerance. The presence of IgE-mediated food allergy at onset was also associated with delayed tolerance (P = .02).
Tolerance development times to egg and nuts were longer than those to CM, beef, and wheat in FPIAP. Delayed tolerance appears to be due to the specific food combinations rather than multiple foods.
关于食物蛋白诱导的过敏性直肠结肠炎（FPIAP），已发表的有关每种致病食物及其组合达到耐受所需时间的信息仍然很少。
确定个体致病食物、致病食物组合达到耐受所需的时间，以及影响耐受发展的因素。
在2019年3月至2020年3月期间诊断为FPIAP的91例患者中，对84例至少随访3年的患者进行了这项前瞻性队列研究。
在最后一次评估时，患者的中位年龄为50个月（四分位间距[IQR]：47 - 54个月），男性占52.4%。第一年耐受发展率为36.6%，第二年为88.9%，第三年为96.4%，3岁以后为97.6%。总体中位耐受发展时间为15.5（IQR：12 - 22.5）个月。对于每种致病食物，牛奶（CM）、牛肉、小麦、鸡蛋和坚果达到耐受的中位时间分别为13（IQR：12 - 18）、13（IQR：12 - 18）、14（IQR：10.7 - 16）、16（IQR：12 - 24）和24（IQR：22.5 - 36.5）个月。在多种食物过敏（MFA）中，鸡蛋的存在显著延长了达到耐受的时间，而牛肉的存在则没有。多因素回归分析显示，存在MFA（比值比[OR]：12.11，95%置信区间[CI]：1.23 - 118.12，P = 0.03）、发病时患有特应性皮炎（AD）（OR：4.04，95% CI：1.15 - 14.25，P = 0.03）以及家中没有宠物（OR：0.23，95% CI：0.06 - 0.87，P = 0.03）与耐受延迟有关。发病时存在IgE介导的食物过敏也与耐受延迟有关（P = 0.02）。
在FPIAP中，对鸡蛋和坚果的耐受发展时间比对CM、牛肉和小麦的更长。耐受延迟似乎是由于特定的食物组合而非多种食物所致。
