The journal of allergy and clinical immunology. Global最新文献

Associations between dietary intake and asthma outcomes: Evidence from pooled analysis in two independent multiethnic Asian cohorts 饮食摄入与哮喘结局之间的关联：来自两个独立的多种族亚洲队列的汇总分析证据

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-20 DOI: 10.1016/j.jacig.2026.100648

Jun Jie Lim BSc , Zongxun Huang MS , Yu Qi Lee PhD , Mary Foong-Fong Chong PhD , Xueling Sim PhD , Mei Hui Liu PhD , Fook Tim Chew PhD

Background

Asthma is a chronic respiratory condition that poses significant public health challenges worldwide, including Singapore.

Objective

Associations between dietary intake and asthma outcomes were assessed in two independent cohorts: the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES; n = 12,172) and the Singapore Multi-Ethnic Cohort Phase 2 follow-up (MEC2_T2; n = 12,353).

Methods

Dietary intake was assessed using a 16-food-group food frequency questionnaire (FFQ) in SMCGES, and a validated 163-item population-specific FFQ in MEC2_T2. Asthma status was determined through self-reported physician diagnosis, with recent asthma attacks and inhaler requirements analyzed as clinically relevant phenotypes. Multivariable logistic regression models adjusted for demographic and lifestyle factors were applied with Bonferroni correction, and meta-analyses across 16 food groups were conducted to derive pooled effect estimates and assess between-cohort heterogeneity.

Results

Asthma prevalence was 19.7% in SMCGES and 9.83% in MEC2_T2. Among patients with asthma, 18.8% (SMCGES) and 18.7% (MEC2_T2) experienced recent asthma attacks, while inhaler requirement was lower in SMCGES (5.9%) than MEC2_T2 (18.4%). Fruit (pooled odds ratio [pOR] = 0.65; 95% confidence interval [CI], 0.57-0.74; P < .001) and nuts (pOR = 0.90; 95% CI, 0.85-0.95; P < .001) intake lowered the odds of asthma, while seafood intake increased the associated odds (pOR = 1.13; 95% CI, 1.07-1.20; P < .001). Fruit intake showed moderate heterogeneity (I² = 63%; P = .10), with no heterogeneity for nuts (I² = 0; P = .69) or seafood (I² = 0, P = .56).

Conclusion

Pooled findings across two independent cohorts highlight specific food groups that may influence asthma outcomes.

哮喘是一种慢性呼吸系统疾病，在包括新加坡在内的世界范围内构成了重大的公共卫生挑战。目的通过新加坡/马来西亚横断面遗传流行病学研究（SMCGES, n = 12,172）和新加坡多种族队列2期随访（MEC2_T2, n = 12,353）两个独立队列评估饮食摄入与哮喘结局之间的关联。方法采用SMCGES的16种食物组食物频率问卷（FFQ）和MEC2_T2的163项人群特异性食物频率问卷（FFQ）对膳食摄入量进行评估。通过自我报告的医生诊断确定哮喘状态，并分析近期哮喘发作和吸入器需求作为临床相关表型。采用Bonferroni校正校正了人口统计学和生活方式因素的多变量logistic回归模型，并对16种食物组进行了荟萃分析，以得出汇总效应估计并评估队列间异质性。结果SMCGES组哮喘患病率为19.7%，MEC2_T2组为9.83%。在哮喘患者中，18.8% （SMCGES）和18.7% （MEC2_T2）最近经历过哮喘发作，而SMCGES（5.9%）的吸入器需求低于MEC2_T2（18.4%）。摄入水果（合并优势比[pOR] = 0.65； 95%可信区间[CI]， 0.57-0.74; P < .001）和坚果（pOR = 0.90; 95% CI, 0.85-0.95; P < .001）降低了哮喘的患病几率，而摄入海鲜则增加了相关的患病几率（pOR = 1.13; 95% CI, 1.07-1.20; P < 001）。水果摄入量显示中等异质性（I2 = 63%; P = 0.10），坚果（I2 = 0; P = 0.69）或海鲜（I2 = 0, P = 0.56）没有异质性。结论：两个独立队列的综合研究结果强调了可能影响哮喘结局的特定食物组。

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引用次数: 0

Anesthetic procedure outcomes after initial perioperative anaphylaxis: A retrospective multicenter US review 初始围手术期过敏反应后的麻醉过程结果：一项美国多中心回顾性综述

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-19 DOI: 10.1016/j.jacig.2026.100645

Saiyara S. Shama MBBS , Ricardo J. Estrada-Mendizabal MD , Christine R.F. Rukasin MD , Bradford B. Smith MD , Gerald W. Volcheck MD , Alexei Gonzalez-Estrada MD

Background

Limited information exists regarding outcomes during repeat surgical procedures in patients with perioperative anaphylaxis (POA). Although current guidelines recommend that future procedures be guided by allergy evaluations, little is known about adherence to these recommendations or risk of recurrence.

Objective

Our aim was to assess the incidence of recurrent POA and evaluate adherence to allergist recommendations during subsequent anesthetic procedures.

Methods

We performed a retrospective review of 100 patients with POA across the Mayo Clinic Health System (2010-2021) to assess subsequent surgical procedures after allergy evaluation. Anesthetic records, allergy workup results, and allergist recommendations were reviewed.

Results

Of 100 patients, 53 underwent at least 1 subsequent anesthetic procedure (median 2, range 1-7), with 81 anesthetic records available. No recurrent POA events were observed. A causative agent was identified in 25 patients (47%) as follows: antibiotics (n = 14), neuromuscular blocking agents (n = 5), and other agents (n = 8). Of the 38 procedures with records in this group, allergist recommendations were fully followed in 29 (76%) and partially followed in 9 (24%). In patients without an identified culprit (n = 28), 49 procedures had records, with partial adherence noted in 12 cases (18%). Deviations often involved substitution or avoidance of neuromuscular blocking agents, even when not implicated.

Conclusion

Although no recurrence was observed, prospective studies are needed to determine whether adherence to allergist recommendations influences long-term outcomes, as well as to better understand documentation and communication practices.

背景：关于围手术期过敏反应（POA）患者重复手术治疗结果的信息有限。虽然目前的指南建议未来的手术应以过敏评估为指导，但对这些建议的遵守或复发风险知之甚少。我们的目的是评估POA复发的发生率，并评估在随后的麻醉过程中对过敏专科医生建议的依从性。方法：我们对梅奥诊所卫生系统（2010-2021）的100例POA患者进行了回顾性研究，以评估过敏评估后的后续外科手术。回顾了麻醉记录、过敏检查结果和过敏专科医生的建议。结果在100例患者中，53例接受了至少1次后续麻醉手术（中位数2，范围1-7），有81例麻醉记录。未观察到复发性POA事件。在25例（47%）患者中确定了以下病原体：抗生素（n = 14），神经肌肉阻滞剂（n = 5）和其他药物（n = 8）。在本组有记录的38例手术中，29例（76%）完全遵循过敏专科医生的建议，9例（24%）部分遵循。在没有确定罪魁祸首的患者中（n = 28）， 49例手术有记录，12例（18%）患者部分遵守。偏差通常涉及替代或避免神经肌肉阻滞剂，即使没有牵连。结论：虽然没有观察到复发，但需要前瞻性研究来确定遵守过敏症医生的建议是否会影响长期结果，以及更好地了解文献和沟通实践。

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引用次数: 0

Distinct blood transcriptomic profiling underlying asthma establishment and exacerbation 不同的血液转录组分析哮喘的建立和恶化

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-19 DOI: 10.1016/j.jacig.2026.100644

Baojun Wu PhD , Mao Yang MS , Donglei Hu PhD , Samantha Hochstadt MS , Bo Hyun Lee PhD , David E. Lanfear MD, MS , Jonathan Witonsky MD, MAS , Paul Stemmer PhD , Esteban G. Burchard MD, MPH , Elad Ziv MD , L. Keoki Williams MD, MPH, MBA

Background

Non-Hispanic Black individuals are disproportionately affected by asthma and severe asthma exacerbations. To elucidate asthma pathogenesis, it is essential to understand the dysregulated gene expression patterns linked to asthma status.

Objective

We sought to characterize whole blood gene expression and molecular pathways associated with asthma progression in non-Hispanic Black individuals.

Methods

RNA sequencing was performed on whole blood samples from individuals enrolled in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE). Participants were categorized into 4 groups based on their clinical status. We characterized transcriptomic signatures specific to distinct disease states: one reflecting asthma establishment and another representing disease exacerbation. From these, we identified candidate biological processes enriched during each transition that are particularly relevant to asthma. Additionally, we pinpointed key molecular drivers and screened for drugs targeting these critical genes.

Results

Compared with healthy control subjects, patients with controlled asthma showed upregulation of genes involved in intestinal IgA production, asthma-related pathways, and antigen processing and presentation. When compared with participants with uncontrolled asthma, individuals with an impending asthma exacerbation had upregulation of genes in pathways associated with Fcγ receptor–mediated phagocytosis, T_H1/T_H2 cell differentiation, and neutrophil extracellular trap formation. Using probabilistic causal analysis of these gene signatures, we identified IL6R, NUMB, and EMG1 as key driver genes in the time period preceding an asthma exacerbation. Our analysis revealed potential treatments to counteract these changes.

Conclusions

Blood gene expression profiling in non-Hispanic Black individuals revealed potential targets and preventive drug candidates for asthma exacerbations, providing new insights for the future treatments.

非西班牙裔黑人个体不成比例地受到哮喘和严重哮喘恶化的影响。为了阐明哮喘的发病机制，有必要了解与哮喘状态相关的基因表达模式失调。目的：研究非西班牙裔黑人个体中与哮喘进展相关的全血基因表达和分子通路。方法对参加哮喘表型和药物基因组相互作用研究（SAPPHIRE）的个体全血样本进行srna测序。根据受试者的临床状况将其分为4组。我们描述了特定于不同疾病状态的转录组特征：一个反映哮喘建立，另一个代表疾病恶化。由此，我们确定了在每个转变过程中富集的候选生物过程，这些过程与哮喘特别相关。此外，我们确定了关键的分子驱动因素，并筛选了针对这些关键基因的药物。结果与健康对照组相比，控制哮喘患者肠道IgA产生、哮喘相关通路、抗原加工和递呈相关基因表达上调。与未控制哮喘的参与者相比，哮喘即将加重的个体在与Fcγ受体介导的吞噬、TH1/TH2细胞分化和中性粒细胞胞外陷阱形成相关的通路中基因上调。通过对这些基因特征的概率因果分析，我们发现IL6R、NUMB和EMG1是哮喘发作前一段时间的关键驱动基因。我们的分析揭示了抵消这些变化的潜在治疗方法。结论非西班牙裔黑人个体的血液基因表达谱揭示了哮喘加重的潜在靶点和预防性候选药物，为未来的治疗提供了新的见解。

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引用次数: 0

Evaluating the concordance of pollen forecasting apps against automated pollen monitoring: A single-site experience 评估花粉预测应用程序与自动花粉监测的一致性：单站点体验

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-12 DOI: 10.1016/j.jacig.2026.100639

Freddy Gonzalez , Christina E. Ciaccio MD, MSc , Sharmilee M. Nyenhuis MD

Background

Individuals with allergic rhinitis and asthma rely on accurate pollen forecasts to avoid allergen exposure and manage symptoms. However, many widely used weather and health applications (apps) use manual pollen counting methods, which may vary in accuracy.

Objective

This study aimed to evaluate the concordance between popular pollen forecasting apps and real-time data collected from an automated pollen monitoring device at a single site in the Chicago area.

Methods

We compared daily pollen forecasts from 2 commonly used consumer apps (The Weather Channel app and the AccuWeather app) with pollen data recorded by the PollenSense automated monitoring device over 2 months. To assess daily concordance, forecasted pollen levels and automated counts were categorized as being in the low, moderate, or high ranges. Descriptive and inferential assessment of accuracy and reliability of consumer-facing pollen forecasts were performed.

Results

Across the study period, concordance between the consumer apps and the PollenSense counts was low (the forecast levels for the AccuWeather app were 7% for grass, 33% for ragweed, and 56% for mold, whereas those for The Weather Channel app were 29% for grass and 34.% for ragweed). No statistically significant association was found between the pollen forecasts and measured pollen levels.

Conclusion

The popular pollen forecasting apps demonstrated poor concordance with real-time automated pollen data. These findings highlight the limitations of current forecasting tools and underscore the need for improved, validated technologies to support clinical decision making and public health recommendations for individuals affected by pollen allergies.

背景：患有变应性鼻炎和哮喘的个体依靠准确的花粉预测来避免过敏原暴露和控制症状。然而，许多广泛使用的天气和健康应用程序（应用程序）使用手动花粉计数方法，其准确性可能有所不同。目的本研究旨在评估流行花粉预测应用程序与芝加哥地区单站点花粉自动监测装置实时采集数据之间的一致性。方法将2个常用的消费者应用程序（The Weather Channel应用程序和AccuWeather应用程序）的每日花粉预报与PollenSense自动监测设备记录的2个月花粉数据进行比较。为了评估每日一致性，预测花粉水平和自动计数被分类为低、中、高范围。对面向消费者的花粉预测的准确性和可靠性进行了描述性和推断性评估。结果在整个研究期间，消费者应用程序与PollenSense数量之间的一致性很低（AccuWeather应用程序对草的预测水平为7%，豚草为33%，霉菌为56%，而天气频道应用程序对草和34的预测水平为29%。）%代表豚草)。花粉预测值与实测值无显著相关。结论流行的花粉预测应用程序与实时自动花粉数据的一致性较差。这些发现突出了当前预测工具的局限性，并强调需要改进和验证技术来支持临床决策和对花粉过敏个体的公共卫生建议。

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引用次数: 0

Anaphylaxis triggered by rennet flower (Withania coagulans): A cautionary tale from traditional medicine 凝血小花引起的过敏反应：一个传统医学的警示故事

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-12 DOI: 10.1016/j.jacig.2026.100640

Jefferson Daniel MD, Sekar Rajasekar MBBS, Devasahayam Jesudas Christopher DNB, FRCP

This case report highlights the first documented instance of anaphylaxis caused by Withania coagulans, a natural remedy widely used in traditional medicine. Given the popularity of W coagulans among Asian communities worldwide, the report’s findings carry essential global clinical relevance.

本病例报告强调了第一个记录的过敏性反应由凝固薇兰引起的实例，一种在传统医学中广泛使用的自然疗法。鉴于W型凝血剂在全球亚洲社区的流行，该报告的发现具有重要的全球临床相关性。

引用次数: 0

Improved food allergy and anaphylaxis knowledge and comfort among internal medicine residents following a brief educational intervention 改善食物过敏和过敏反应的知识和舒适度在内科住院医师经过简短的教育干预

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-09 DOI: 10.1016/j.jacig.2026.100643

Stephanie Jeong MD, Scott H. Sicherer MD

Background

Self-injectable epinephrine (SIE) is the first line of defense against anaphylaxis, a potentially life-threatening allergic reaction commonly triggered by food. Internal medicine residents play a crucial role in managing food allergy and anaphylaxis, but knowledge and comfort in doing so may vary.

Objective

The purpose of the study was to assess the efficacy of a brief educational intervention on improving internal residents’ preparedness to manage food allergies, specifically focusing on prescribing and counseling patients regarding SIE use.

Methods

A survey assessing residents’ understanding and comfort was administered, followed by a presentation of a brief educational module and subsequent completion of a postintervention survey.

Results

Thirty-four residents completed both the preintervention and postintervention surveys. Almost all participants reported improvement in their comfort levels for both prescribing and counseling patients on the use of SIE (P < .05). Pre-post knowledge improved from 83% to 97% (P = .02) regarding the correct location of epinephrine injection, and from 37% to 65% (P = .01) regarding appropriate scenarios for prescribing SIE. Ninety-four percent of participants rated the intervention as helpful.

Conclusions

A brief educational module for internal medicine residents showed strong efficacy and participant satisfaction.

自注射肾上腺素（SIE）是预防过敏反应的第一道防线，这是一种通常由食物引发的可能危及生命的过敏反应。内科住院医师在处理食物过敏和过敏反应方面发挥着至关重要的作用，但在这方面的知识和舒适度可能有所不同。目的本研究的目的是评估一个简短的教育干预在提高住院医师管理食物过敏的准备方面的效果，特别是集中在处方和咨询患者关于SIE的使用。方法进行一项调查，评估居民的理解和舒适度，然后介绍一个简短的教育模块，随后完成干预后的调查。结果34名居民完成了干预前和干预后的问卷调查。几乎所有的参与者都报告说，在处方和咨询患者使用SIE时，他们的舒适度都有所提高（P < 0.05）。对于肾上腺素注射的正确位置，前后知识从83%提高到97% (P = 0.02)，对于处方SIE的适当情况，前后知识从37%提高到65% （P = 0.01）。94%的参与者认为干预是有帮助的。结论简易内科住院医师教育模块具有较强的教学效果和满意度。

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引用次数: 0

Aims and scope 目标及范围

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-01 DOI: 10.1016/S2772-8293(25)00233-4

引用次数: 0

Specialist physician perspectives on clinical decision support to address secondary vaccine hesitancy 专科医生对临床决策支持的观点，以解决二次疫苗犹豫

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-22 DOI: 10.1016/j.jacig.2025.100636

Anjali Nemorin MPH , Dylan T. Norton BA , Chloe V. Green MURP , Michelle S. Jerry BS , Alysse G. Wurcel MD, MS , Kimberly G. Blumenthal MD, MSc

Background

Vaccines are an evidence-based intervention that mitigates the impact of infections, yet many Americans indicate hesitancy toward receiving vaccines. One of the most common reasons for this is the potential for experiencing adverse reactions when receiving vaccines. The current literature shows that clinical decision support (CDS) tools have been utilized to improve vaccine coverage.

Objective

Our aim was to assess specialist physician experiences, practices, and levels of comfort with evaluating adverse and allergic reactions to vaccines, as well as with addressing secondary vaccine hesitancy, using CDS tools.

Methods

Researchers conducted 10 semistructured interviews with physicians in Mass General Brigham’s Infectious Diseases and Allergy/Immunology units. The interview guide consisted of 11 questions divided into 4 sections: vaccine conversations, vaccine allergies/reactions, CDS, and structural facilitators/barriers. The interview responses were evaluated by using rapid thematic analysis.

Results

Specialist physicians were generally comfortable talking to patients about vaccine hesitancy but were also open to CDS tools that effectively and efficiently contribute to improved conversations around secondary vaccine hesitancy to increase vaccine uptake. Desired CDS tool features include sharing educational visuals and videos with patients. The risks involve operational delays and lack of real-time data and accountability structures. Clinic modifications such as longer appointment times or group appointments were considered as other ways to help address vaccine hesitancy.

Conclusion

Specialist physicians expressed interest in using CDS tools to improve vaccine-related conversations with their patients. Future CDS tools must account for timely vaccine information and workflow efficiency issues. Future research should include generalist physicians, other health care team members, and patients.

疫苗是一种基于证据的干预措施，可以减轻感染的影响，但许多美国人表示对接种疫苗犹豫不决。最常见的原因之一是接种疫苗时可能出现不良反应。目前的文献显示，临床决策支持（CDS）工具已被用于提高疫苗覆盖率。目的：我们的目的是评估专科医生在使用CDS工具评估疫苗不良反应和过敏反应以及处理二次疫苗犹豫方面的经验、做法和舒适度。研究人员对麻省总医院布里格姆感染性疾病和过敏/免疫学部门的医生进行了10次半结构化访谈。访谈指南包括11个问题，分为4个部分：疫苗对话、疫苗过敏/反应、CDS和结构性促进因素/障碍。通过快速主题分析对访谈反应进行评估。结果专科医生通常愿意与患者谈论疫苗犹豫，但也对CDS工具持开放态度，这些工具有效且高效地有助于改善围绕二次疫苗犹豫的对话，以增加疫苗吸收率。期望的CDS工具功能包括与患者共享教育视觉和视频。风险包括操作延迟、缺乏实时数据和问责制结构。诊所的改变，如延长预约时间或团体预约，被认为是帮助解决疫苗犹豫的其他方法。专家医生表示有兴趣使用CDS工具来改善与患者的疫苗相关对话。未来的CDS工具必须考虑到及时的疫苗信息和工作流程效率问题。未来的研究应该包括全科医生、其他医疗团队成员和患者。

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引用次数: 0

Rising trends in infant ER encounters for food-induced allergic reactions in the era of early allergenic food introduction 在早期过敏性食物引入时代，婴儿ER遭遇食物引起的过敏反应的上升趋势

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-22 DOI: 10.1016/j.jacig.2025.100637

Aaron Chin MD , Ali Doroudchi MD , Derek C. Pham BS , Nicholas J. Jackson PhD, MPH , Maria I. Garcia-Lloret MD

Background

Allergic reactions to food are a leading cause of pediatric emergency room (ER) visits. National guidelines now recommend early introduction of allergenic foods; however, whether these changes have affected ER encounters remains poorly understood.

Objective

Our aim was to observe trends in ER encounters for food-induced reactions (FIRs), including food-induced anaphylaxis (FIA), among children aged 0 to 5 years between 2013 and 2024.

Methods

We performed a retrospective analysis of ER visits at the University of California Los Angeles from 2013 to 2024. FIRs were identified by using International Classification of Diseases codes and stratified by age (0-1 vs 2-5 years). Logistic regression assessed annual trends. Multivariate logistic regression was used to compare postguideline years (2022-2024) with preguideline years (2013-2016), adjusting for clinical and demographic variables.

Results

Of 67,059 ER visits, 350 FIRs and 182 FIA visits were identified. FIR and FIA annual rates increased significantly over time in infants aged 0 to 1 years (odds ratio [OR] = 1.15 [P = .005] and OR = 1.27 [P = .002]). In children aged 2 to 5 years old, neither FIR nor FIA rates increased. Refractory anaphylactic reactions did not change in either group. In multivariate analysis, infants in the postguideline period had more than twice the odds of a FIR during the preguideline years (OR = 2.21 [95% CI = 1.37-3.55]), whereas no change was observed in the 2- to 5-year age group (OR = 0.82 [95% CI = 0.55-1.2]).

Conclusion

ER visits for food reactions have continued to rise at a steady rate over time among infants. These findings underscore the need for additional research on adoption, parental guidance, and long-term impact of early allergen introduction.

食物过敏反应是儿童急诊室就诊的主要原因。国家指南现在建议尽早引入致敏食物；然而，这些变化是否影响了急诊就诊仍然知之甚少。我们的目的是观察2013年至2024年间0至5岁儿童因食物引起的反应（FIRs）（包括食物引起的过敏反应（FIA））而遭遇ER的趋势。方法回顾性分析2013年至2024年加州大学洛杉矶分校急诊室就诊情况。首先采用国际疾病分类代码进行鉴定，并按年龄（0-1岁vs 2-5岁）分层。Logistic回归评估了年度趋势。采用多变量logistic回归比较指南后年份（2022-2024年）和指南前年份（2013-2016年），调整临床和人口统计学变量。结果67059例急诊就诊中，有350例FIRs和182例FIA就诊。随着时间的推移，0 ~ 1岁婴儿的FIR和FIA年发病率显著增加（比值比[OR] = 1.15 [P = 0.005]和OR = 1.27 [P = 0.002]）。在2至5岁的儿童中，FIR和FIA率均未增加。两组患者的难治性过敏反应均未发生变化。在多变量分析中，指南后时期的婴儿在指南前年份发生FIR的几率是指南前年份的两倍多（OR = 2.21 [95% CI = 1.37-3.55]），而2- 5岁年龄组没有变化（OR = 0.82 [95% CI = 0.55-1.2]）。随着时间的推移，婴儿因食物反应而就诊的人数持续稳定上升。这些发现强调了对收养、父母指导和早期引入过敏原的长期影响进行进一步研究的必要性。

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引用次数: 0

Potential for gradual tolerance acquisition in egg yolk–induced FPIES: A case series 在蛋黄诱导的FPIES中逐渐获得耐受性的潜力：一个病例系列

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-20 DOI: 10.1016/j.jacig.2025.100635

Tomoaki Kunitsu MD , Kana Hamanaka MD , Midori Tagaya MD , Kazuo Nonomura MD, PhD

Background

Food protein–induced enterocolitis syndrome (FPIES) caused by egg yolk is increasingly recognized in Japan, yet the optimal timing for oral food challenge (OFC) and the process of tolerance acquisition remain unclear.

Objective

Our aim was to investigate the clinical outcomes of early OFC (performed 90-120 days after the last symptomatic episode) in children with egg yolk–induced FPIES, with a focus on identifying a potential transitional tolerance phase.

Methods

We conducted a retrospective analysis of a case series of 3 patients with egg yolk–induced FPIES who underwent early OFC. Subsequent ingestion outcomes and clinical symptoms were analyzed.

Results

All 3 patients had negative OFC results but experienced mild gastrointestinal symptoms such as persistent diarrhea or recurrent vomiting during repeated ingestion at home. These features suggested a transitional tolerance phase. Full tolerance was achieved within 6 to 7 months in all cases.

Conclusion

Early OFC may be conducted at a time that is suboptimal for reliable confirmation of tolerance. A negative OFC result does not necessarily indicate acquisition of full tolerance. Clinicians should be aware of a transitional phase during which symptoms may recur despite initial OFC success. Continued ingestion and close monitoring are essential to confirm full tolerance.

背景：在日本，蛋黄引起的食物蛋白性小肠结肠炎综合征（FPIES）越来越被认识到，但口服食物挑战（OFC）的最佳时机和耐受性获得过程仍不清楚。我们的目的是研究蛋黄诱导的FPIES儿童早期OFC（在最后一次症状发作后90-120天进行）的临床结果，重点是确定潜在的过渡耐受期。方法回顾性分析了3例早期OFC的蛋黄性FPIES患者。分析随后的摄入结果和临床症状。结果3例患者均为OFC阴性，但在家中反复服用时出现持续腹泻或反复呕吐等轻微胃肠道症状。这些特征表明存在过渡耐受阶段。所有病例均在6 - 7个月内完全耐受。结论早期OFC可能不是可靠确认耐受性的最佳时间。OFC阴性结果并不一定表明获得了完全耐受。临床医生应该意识到一个过渡阶段，在这个阶段，尽管最初的OFC成功，但症状可能会复发。持续摄入和密切监测对于确认完全耐受至关重要。

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引用次数: 0