Journal of Clinical Pediatrics ›› 2024, Vol. 42 ›› Issue (4): 285-290.doi: 10.12372/jcp.2024.24e0162
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LI Zailing
Received:2024-03-05
Published:2024-04-15
Online:2024-04-09
LI Zailing. Focus on the identification of digestive symptoms associated with food allergy[J].Journal of Clinical Pediatrics, 2024, 42(4): 285-290.
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| 临床特征 | FPIES | FPIP | FPIE | EG |
|---|---|---|---|---|
| 发作年龄 | 数天至1岁 | 数天至6月龄 | 2~24月龄 | 任何年龄 |
| 症状 | ||||
| 呕吐 | 明显 | 无 | 间歇性 | 间歇性 |
| 腹泻 | 重度 | 无 | 中度 | 中度 |
| 血便 | 重度 | 中度 | 罕见 | 中度 |
| 水肿 | 急性、重度(罕见) | 无 | 中度 | 中度 |
| 休克 | 15%~20% | 无 | 无 | 无 |
| 生长迟缓 | 中度 | 无 | 中度 | 中度 |
| 过敏评估 | ||||
| 食物皮肤点刺试验 | 阴性 | 阴性 | 阴性 | 阳性~50% |
| 血清食物特异性IgE | 阴性 | 阴性 | 阴性 | 阳性~50% |
| IgE总量 | 正常 | 正常 | 正常 | 正常至升高 |
| 外周血嗜酸性粒细胞增多 | 无 | 偶有 | 无 | 阳性~50% |
| 活检结果 | ||||
| 绒毛损伤 | 不完整的,可变性 | 无 | 可变性 | 可变性 |
| 结肠炎 | 明显 | 病灶 | 无 | 可能有 |
| 黏膜糜烂 | 偶有 | 偶有,线性的 | 无 | 可能有 |
| 淋巴结增生 | 无 | 常见 | 无 | 有 |
| 嗜酸性粒细胞 | 明显 | 明显 | 较少 | 明显,也有嗜中性粒细胞浸润,基底层增生和乳头状延长 |
| 食物激发 | 1.5~3 h内发生呕吐;5~8 h内发生腹泻 | 6~72 h内发生直肠出血 | 40~72 h内发生呕吐、腹泻或两者都有 | 数小时至数天内发生呕吐和腹泻 |
"
| 疾病 | 特点 | 可能症状 |
|---|---|---|
| 感染性胃肠炎 | 单次发作,伴发热,有感染源接触史 | 腹泻、便血 |
| 败血症 | 需要抗感染治疗,仅补液治疗无效 | 腹泻、便血 |
| NEC | 多见于新生儿,病情进展快;血便,感染性休克;腹平片见腹壁积气 | 腹泻、便血 |
| 严重过敏反应 | 进食触发食物后即刻2小时内出现,常伴其他系统(呼吸道、皮肤、心血管)症状,食物特异性IgE阳性。 | 腹泻、便血 |
| 先天性代谢缺陷(尿素代谢循环障碍、果糖不耐受、高氨血症、线粒体病等) | 发育迟滞,神经系统症状,进食水果加重 | 腹泻 |
| 免疫性肠道疾病(炎症性肠病、自身免疫性肠病、免疫缺陷病) | 罕见病,发病与进食某种食物无关 | 腹泻、便血 |
| 先天性巨结肠 | 首次胎便排出延迟,腹胀明显 | 便秘 |
| 消化道畸形 | 可通过影像学检查鉴别 | 便秘、便血 |
| 全身出血性疾病 | 其他系统出血表现,发病与进食某种食物无关 | 便血 |
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