Humoral and cellular responses to casein in patients with food protein-induced enterocolitis to cow's milk.

Abstract

BACKGROUND:

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy manifesting within 1 to 4 hours of food ingestion with repetitive emesis and lethargy.

OBJECTIVE:

We sought to characterize immune responses to casein in children with FPIES caused by cow's milk (CM).

METHODS:

Total IgE and IgM, CM-specific IgG, and casein-specific IgE, IgG, IgG4, and IgM levels, as well as immunoglobulin free light chains, were measured in both patients with active and those with resolved CM-FPIES. Proliferating casein/T-effector cell counts were measured in children with CM-FPIES, children with IgE-mediated CM allergy, and those tolerating CM. Cytokine concentrations in the supernatants were quantified. Serum cytokine and tryptase levels were measured before and after a positive oral food challenge (OFC) result and compared with levels in those with a negative OFC result.

RESULTS:

We found low levels of CM and casein-specific IgG and casein-specific IgG4 in patients with CM-FPIES versus those tolerating CM (P < .05). Although we found both a high CD4+ T cell-proliferative response and TH2 cytokines production after casein stimulation in children with CM-FPIES, results were similar to those in control subjects. Significantly lower secretion of IL-10 and higher secretion of IL-9 by casein-stimulated T cells were found in patients with CM-FPIES versus those with IgE-mediated CM allergy. Lower baseline serum levels of IL-10 and higher tryptase levels were found in active CM-FPIES versus resolved CM-FPIES. We found a significant increase in serum IL-10 and IL-8 levels after a positive OFC result.

CONCLUSIONS:

We confirm the paucity of humoral response in patients with CM-FPIES. IL-10 might play a key role in acquisition of tolerance in patients with CM-FPIES. Increased serum IL-8 levels in patients with active FPIES suggest neutrophil involvement. Elevated baseline serum tryptase levels in patients with active FPIES suggest low-grade intestinal mast cell activation or increased mast cell load.

• Authors: Jean Christoph Caubet, Ramon Bencharitiwong, Andrew Ross, Hugh A Sampson, M Cecilia Berin, Anna Nowak-Węgrzyn
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 139 Issue 2 Pg. 572-583 (02 2017) ISSN: 1097-6825 [Electronic] United States
• PMID: 27545065 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2016. Published by Elsevier Inc.

Chemical References

• Allergens
• Caseins
• Interleukin-8
• Interleukin-10
• Tryptases

Topics

• Allergens (immunology, metabolism)
• Animals
• Caseins (immunology, metabolism)
• Cattle
• Cells, Cultured
• Child
• Enterocolitis (chemically induced, immunology)
• Female
• Humans
• Immune Tolerance
• Immunity, Cellular
• Immunity, Humoral
• Interleukin-10 (blood)
• Interleukin-8 (blood)
• Male
• Milk Hypersensitivity (immunology)
• Tryptases (blood)