Acute typical food protein-induced enterocolitis syndrome triggered by egg white: Two case reports.

IF 2.1 4区 医学 Q3 ALLERGY
Allergologia et immunopathologia Pub Date : 2025-07-01 eCollection Date: 2025-01-01 DOI:10.15586/aei.v53i4.1345
Kosei Yamashita, Yuki Okada, Ikuya Sasaki, Sawa Seki, Toshiyuki Takagi, Megumi Okawa, Aiko Honda, Chihiro Kunigami, Mayu Maeda, Taro Kamiya, Takanori Imai
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引用次数: 0

Abstract

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.

蛋清诱发急性典型食物蛋白性小肠结肠炎综合征2例报告
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,以呕吐和腹泻等胃肠道症状为特征。自2018年以来,蛋黄一直是日本最常见的FPIES诱因,而典型的蛋清(TEW) FPIES仍然很少见。在此,我们提出两例急性TEW儿童FPIES。一名17个月大的女婴在摄入蛋清后出现了反复呕吐和嗜睡,尽管之前她只吃了半个蛋黄和5克蛋清。初步试验未见致敏标志物(蛋清特异性IgE < 0.1 kUA/L;卵泡样蛋白[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3次口服食物挑战(OFCs)均引发呕吐和嗜睡。降钙素原、胸腺和激活调节的趋化因子水平在24小时内保持升高,甚至在31个月后,患者仍未达到蛋清耐受。一名14个月大的女婴在严格不含蛋黄和蛋清的饮食中摄入蛋清后出现呕吐和嗜睡。再次血检未见致敏标志物(蛋清特异性IgE < 0.1 kUA/L;ovm特异性IgE < 0.1 kUA/L;SPT -)。两个间隔6个月的OFCs证实了FPIES,即使在2年后,患者也没有达到蛋清耐受。这些病例表明,蛋清可以引发非典型肺炎。全面的病史记录和诊断评估,包括OFCs,是区分FPIES和即时性食物过敏的必要条件。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
131
审稿时长
6-12 weeks
期刊介绍: Founded in 1972 by Professor A. Oehling, Allergologia et Immunopathologia is a forum for those working in the field of pediatric asthma, allergy and immunology. Manuscripts related to clinical, epidemiological and experimental allergy and immunopathology related to childhood will be considered for publication. Allergologia et Immunopathologia is the official journal of the Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) and also of the Latin American Society of Immunodeficiencies (LASID). It has and independent international Editorial Committee which submits received papers for peer-reviewing by international experts. The journal accepts original and review articles from all over the world, together with consensus statements from the aforementioned societies. Occasionally, the opinion of an expert on a burning topic is published in the "Point of View" section. Letters to the Editor on previously published papers are welcomed. Allergologia et Immunopathologia publishes 6 issues per year and is included in the major databases such as Pubmed, Scopus, Web of Knowledge, etc.
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