We describe the case of a child affected by milk-protein induced enterocolitis, in which oral challenge with corn was performed without symptoms after a negative specific Atopy Patch Test. Food protein-induced enterocolitis syndrome (FPIES) is an uncommon non-IgE-mediated gastrointestinal food hypersensitivity of infancy, characterized by severe vomiting and diarrhea arising within 1 to 3 hours after ingestion of the causative food. Little is known about the pathophysiology of FPIES. The absence of food-specific IgE as demonstrated by negative skin prick tests suggests that the disease is not caused by an early onset IgE-mediated reaction. Atopy Patch Test has been described as sensitive and predictive in this syndrome. The hypothesis on the immunological pathogenesis has been discussed on the basis of literature data.
Nowak-WegrzynASampsonHAWoodRASichererSH. Food protein induced enterocolitis syndrome caused by solid food proteins. Pediatrics2003; 111:829–35.
5.
SichererSHEigenmannPASampsonHA. Clinical features of food protein-induced entercolitis syndrome. J Pediatr1998; 133:214–19.
6.
FoggMIBrown-WhitehornTAPawlowskiNASpergelJM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol2006; 17:351–55.
7.
PowellGK. Milk- and soy-induced enterocolitis of infancy. J Pediatr1978; 93:553–60.
KarlssonMRRugtveitJBrandtzaegP. Allergen-responsive CD4+CD25+ regulatory T cells in children who have outgrown cow's milk allergy. J Exp Med2004; 199:1679–88.
12.
Van SickleGJPowellGKMcDonaldPJGoldblumRM. Milk- and soy protein-induced enterocolitis: evidence for lymphocyte sensitization to specific food proteins. Gastroenterology1985; 88:1915–21.
13.
MajamaaHMiettinenALaineSIsolauriE. Intestinal inflammation in children with atopic eczema: faecal eosinophil cationic protien and tumour necrosis factor-a as non-invasive indicators of food allergy. Clin Exp Allergy1995; 26:181–87.
14.
ChungHLHwangJBParkJJKimSG. Expression of transforming growth factor β1, transforming growth factor type I and II receptors, and TNF-α in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol2002; 109:150–54.
15.
CoatesRWWeaverKRLloydRCeccacciNGreenbergMR. Food protein-induced enterocolitis syndrome as a cause for infant hypotension. West J Emerg Med2011; 12:512–14.
16.
JarryABossardCBou-HannaCMassonDEspazeEDenisMGLaboisseCL. Mucosal IL-10 and TGF-β play crucial roles in preventing LPS-driven, IFN-γ—mediated epithelial damage in human colon explantsJ Clin Invest2008;118:1132–42.
17.
LevingsMKRoncaroloMG. T-regulatory 1 cells: a novel subset of CD4+ T cells with immunoregulatory properties. J Allergy Clin Immunol2000; 106:S109–S112.
18.
AssemanCPowrieF. Interleukin-10 is a growth factor for a population of regulatory T-cell. Gut1998; 42:157–58.
19.
CardosoCRProvinciattoPRGodoiDFFerreiraBRTeixeiraGRossiMACunhaFQSilvaJS. IL-4 regulates susceptibility to intestinal inflammation in murine food allergy. Am J Physiol Gastrointest Liver Physiol2009; 296:G593–G600.
20.
MoriFBarniSCianferoniAPucciNde MartinoMNovembreE. Cytokine expression in CD3+ cells in an infant with food protein-induced enterocolitis syndrome (FPIES): case report. Clin Dev Immunol2009; article ID 679381.
21.
ShekLPBardinaLCastroRSampsonHABeyerK. Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and non-IgE-mediated disorders. Allergy2005; 60:912–19.
KabelitzDMarischenLObergHHHoltmeierWWeschD. Epithelial defence by γ δ T cells. Int Arch Allergy Immunol2005; 137:73–81.
24.
Guy-GrandDVassalliP. Gut intraepithelial lymphocyte development. Curr Opin Immunol2002; 14:255–59.
25.
JärvinenKMCaubetJCSicklesLFordLSSampsonHANowak-WęrzynA. Poor utility of atopy patch test in predicting tolerance development in food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol2012; 109:221–22.
