Yamashita Kosei, Okada Yuki, Sasaki Ikuya, Seki Sawa, Takagi Toshiyuki, Okawa Megumi, Honda Aiko, Kunigami Chihiro, Maeda Mayu, Kamiya Taro, Imai Takanori
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan;
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
Allergol Immunopathol (Madr). 2025 Jul 1;53(4):141-145. doi: 10.15586/aei.v53i4.1345. eCollection 2025.
Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated food allergy characterized by gastrointestinal symptoms such as vomiting and diarrhea. Since 2018, hen's egg yolk has been the most common trigger for FPIES in Japan, whereas typical egg white (TEW) FPIES remains rare. Herein, we present two cases of acute TEW FPIES in young children. A 17-month-old girl experienced recurrent vomiting and lethargy following egg white ingestion, despite previously tolerating half an egg yolk and 5 g of egg white. Initial tests showed no sensitization markers (egg white-specific IgE < 0.1 kUA/L; ovomucoid [OVM]-specific IgE < 0.1 kUA/L; skin prick test [SPT] negative). Three oral food challenges (OFCs) at 6-month intervals at our hospital all triggered vomiting and lethargy. Procalcitonin and thymus- and activation-regulated chemokine levels remained elevated for 24 hours, and even after 31 months, the patient had not achieved egg white tolerance. A 14-month-old girl presented with vomiting and lethargy after egg white ingestion while on a strict egg yolk- and egg white-free diet. Blood tests again showed no sensitization markers (egg white-specific IgE < 0.1 kUA/L; OVM-specific IgE < 0.1 kUA/L; SPT negative). Two OFCs at 6-month intervals confirmed FPIES, and even after 2 years, the patient had not achieved egg white tolerance. These cases highlight that egg white can trigger FPIES. Thorough medical history taking and diagnostic evaluation, including OFCs, are essential to distinguish FPIES from immediate-type food allergies.
食物蛋白诱导的小肠结肠炎综合征（FPIES）是一种非免疫球蛋白E（IgE）介导的食物过敏，其特征为呕吐和腹泻等胃肠道症状。自2018年以来，蛋黄一直是日本FPIES最常见的诱发因素，而典型蛋清（TEW）FPIES仍然罕见。在此，我们报告两例幼儿急性TEW FPIES病例。一名17个月大的女孩在摄入蛋清后出现反复呕吐和嗜睡，尽管此前她能耐受半个蛋黄和5克蛋清。初步检查未发现致敏标志物（蛋清特异性IgE<0.1 kUA/L；卵类粘蛋白[OVM]特异性IgE<0.1 kUA/L；皮肤点刺试验[SPT]阴性）。在我们医院每隔6个月进行的三次口服食物激发试验（OFC）均引发了呕吐和嗜睡。降钙素原以及胸腺和活化调节趋化因子水平在24小时内一直升高，甚至在31个月后，该患者仍未达到蛋清耐受。一名14个月大的女孩在严格避免食用蛋黄和蛋清的饮食期间摄入蛋清后出现呕吐和嗜睡。血液检查再次未发现致敏标志物（蛋清特异性IgE<0.1 kUA/L；OVM特异性IgE<0.1 kUA/L；SPT阴性）。每隔6个月进行的两次OFC确诊为FPIES，甚至在2年后，该患者仍未达到蛋清耐受。这些病例表明蛋清可引发FPIES。详细的病史采集和包括OFC在内的诊断评估对于区分FPIES与速发型食物过敏至关重要。
