title: Inflammatory events during food protein-induced enterocolitis syndrome reactions.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Valentina
authors.identifier: 0000-0001-6908-8125
authors.initials: V
authors.lastname: Pecora
authors.affiliation: Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Giusi
authors.initials: G
authors.lastname: Prencipe
authors.affiliation: Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Valluzzi
authors.affiliation: Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Lamia
authors.initials: L
authors.lastname: Dahdah
authors.affiliation: Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Insalaco
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cianferoni
authors.affiliation: Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Benedetti
authors.affiliation: Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
mesh_terms: D000208:Acute Disease; D000485:Allergens / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D004044:Dietary Proteins / Q000276:immunology*; D004760:Enterocolitis / Q000097:blood / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D009504:Neutrophils / Q000378:metabolism; D013577:Syndrome; D013601:T-Lymphocytes / Q000378:metabolism
chemical_list: D000485:Allergens; D015415:Biomarkers; D004044:Dietary Proteins; D002097:C-Reactive Protein
keywords: C-reactive protein; T-cell food-specific mechanisms; food protein-induced enterocolitis syndrome; inflammatory mechanisms