Inflammatory events during food protein-induced enterocolitis syndrome reactions

Valentina Pecora, Giusi Prencipe, Rocco Valluzzi, Lamia Dahdah, Antonella Insalaco, Antonella Cianferoni, Fabrizio De Benedetti, Alessandro Fiocchi

Research output: Contribution to journalArticle

Abstract

Background: An increasing number of infants are diagnosed with food protein-induced enterocolitis syndrome (FPIES), a non-IgE-mediated food allergy. Until now, T-cell, food-specific mechanisms have been hypothesized. Methods: Sixteen children (11M, 5F), affected by FPIES from cow's milk, wheat, fruit, rice, and others, experienced 25 acute episodes managed at our emergency department (ED) and eight FPIES reactions during oral food challenges (OFC). We compared the laboratory data in resting conditions, in the absence of infectious diseases, with data collected during the 25 acute ED episodes (blood samples drawn at 2-12 hours) and the eight positive OFCs (three samples at 2, 6, and 12 hours). The onset of symptoms was used as a reference time point. Results: In basal conditions, total IgE, WBC, neutrophil and eosinophil count, CRP, and SGPT were found normal. LDH and SGOT values were high (627.81±97.88 and 45.75±10.26 UI/L, respectively). During ED reactions, LDH and SGOT increased to 794.21±247.28 (P=.028) and 51.08±16.99 UI/L (P=.14) and neutrophils count and CRP to 8.44±3.82×103/μL (P=.0009) and 3.27±5.73 mg/dL (P=.0014), respectively. During positive OFC, LDH and SGOT did not vary significantly; CRP increased from 0.14±0.18 to 2.49±3.65 mg/dL (P=.00189) and neutrophil count from 2.79±1.42 to 7.10±3.98×103/μL (P=.00096). Conclusions: FPIES reactions are characterized by neutrophilia and by a time-dependent, significant increase in CRP, indicating that inflammatory mechanisms are in place. This suggests new directions for research on FPIES pathogenesis.

Original languageEnglish
Pages (from-to)464-470
Number of pages7
JournalPediatric Allergy and Immunology
Volume28
Issue number5
DOIs
Publication statusPublished - Aug 1 2017

Keywords

  • C-reactive protein
  • food protein-induced enterocolitis syndrome
  • inflammatory mechanisms
  • T-cell food-specific mechanisms

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Immunology

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