title: Cytokine expression in CD3+ cells in an infant with food protein-induced enterocolitis syndrome (FPIES): case report.
abstract: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by severe vomiting, diarrhea, and often failure to thrive in infants. Symptoms typically resolve after the triggering food-derived protein is removed from the diet and recur within few hours after the re-exposure to the causal protein. The diagnosis is based on clinical symptoms and a positive food challenge. In this study, we report a case of FPIES to rice in an 8-month-old boy. We performed a double-blind placebo-controlled food challenge (DBPCFC) to rice and we measured the intracellular T cell expression of interleukin-4 (IL-4); IL-10, and interferon gamma (IFN-gamma) pre-and post-challenge during an acute FPIES reaction and when tolerance to rice had been achieved. For the first time we describe an increase in T cell IL-4 and decrease in IFN-gamma expression after a positive challenge with rice (i.e. rice triggered a FPIES attack) and an increase in T cell IL-10 expression after rice challenge 6 months later after a negative challenge (i.e., the child had acquired tolerance to rice) in an 8 month old with documented FPIES to rice. A Th2 activation associated with high IL-4 levels may contribute to the pathophysiology of the disease. On the other hand, T cell-derived IL-10 may play a role in the acquisition of immunotolerance by regulating the Th1 and Th2 responses.
authors.affiliation: Allergy and Clinical Immunology Unit, Department of Pediatrics, Meyer Children Hospital, University of Florence, 50122 Florence, Italy. f.mori@meyer.it
authors.forename: F
authors.initials: F
authors.lastname: Mori
authors.forename: S
authors.initials: S
authors.lastname: Barni
authors.forename: A
authors.initials: A
authors.lastname: Cianferoni
authors.forename: N
authors.initials: N
authors.lastname: Pucci
authors.forename: M
authors.initials: M
authors.lastname: de Martino
authors.forename: E
authors.initials: E
authors.lastname: Novembre
mesh_terms: D001942:Breast Feeding; D017252:CD3 Complex / Q000096:biosynthesis; D016207:Cytokines / Q000378:metabolism; D003967:Diarrhea; D004760:Enterocolitis / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007108:Immune Tolerance; D007114:Immunization; D007223:Infant; D008297:Male; D012275:Oryza / Q000009:adverse effects* / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D014839:Vomiting
chemical_list: D017252:CD3 Complex; D016207:Cytokines