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Eosinophilia in infants with food protein-induced enterocolitis syndrome in Japan
Mitsuaki Kimura1, Masaki Shimomura1, Hideaki Morishita1
1Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
Insights
Eosinophilia in Japanese infants with food protein-induced enterocolitis syndrome (FPIES) varies by onset. Early-onset FPIES shows higher eosinophil levels, linked to increased IL-5 production, unlike late-onset FPIES.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Allergy Research
Background:
- Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy.
- Eosinophilia is observed in FPIES, but its characteristics and relationship with disease onset require further elucidation.
- Previously, eosinophilia was considered characteristic of food protein-induced proctocolitis (FPIP).
Purpose of the Study:
- To investigate the characteristics of eosinophilia in Japanese infants diagnosed with FPIES.
- To differentiate eosinophil patterns between FPIES and FPIP.
- To explore the correlation between eosinophil levels, clinical symptoms, and disease onset in FPIES.
Main Methods:
- 113 infants with non-IgE-mediated cow's milk allergy were studied, categorized into FPIES (n=94) and FPIP (n=19).
- Peripheral blood eosinophil percentages (Eo) were analyzed.
- IL-5 production by T cells stimulated with cow's milk protein was measured in early- and late-onset FPIES groups.
Main Results:
- Eosinophil percentages were comparable between FPIES (median 7.5%) and FPIP (median 9.0%).
- In FPIES, eosinophilia correlated positively with vomiting and bloody stool, and was highest in patients with simultaneous vomiting, bloody stool, and diarrhea.
- Early-onset FPIES (≤10 days) exhibited significantly higher eosinophil levels (median 9.8%) and IL-5 production compared to late-onset FPIES (>10 days, median 5.4%).
Conclusions:
- Japanese FPIES infants exhibit two distinct eosinophilia patterns: conspicuous in early-onset and mild in late-onset.
- Abnormally high IL-5 production is implicated as the cause of conspicuous eosinophilia in early-onset FPIES.
- These findings differentiate FPIES subtypes and highlight the role of IL-5 in early-onset disease.
Background:
Many Japanese infants with food protein-induced enterocolitis syndrome (FPIES) show eosinophilia, which has been thought to be a characteristic of food protein-induced proctocolitis (FPIP).
Methods:
To elucidate the characteristics of eosinophilia in Japanese FPIES patients, 113 infants with non-IgE-mediated gastrointestinal food allergy due to cow's milk were enrolled and classified into FPIES (n = 94) and FPIP (n = 19).
Results:
The percentage of peripheral blood eosinophils (Eo) was increased in most FPIES patients (median, 7.5%), which was comparable with that in FPIP patients (9.0%). Among FPIES patients, Eo was the highest in patients who had vomiting, bloody stool, and diarrhea simultaneously (12.9%) and lowest in patients with diarrhea alone (3.2%). Eo showed a significant positive correlation with the incidence of vomiting (Cramer's V = 0.31, p < 0.005) and bloody stool (Cramer's V = 0.34, p < 0.0005). A significant difference was found in Eo between early- (≤10 days, n = 56) and late-onset (>10 days, n = 38) FPIES (median, 9.8% vs. 5.4%; p < 0.005). IL-5 production by peripheral blood T cells stimulated with cow's milk protein in early-onset FPIES was significantly higher than that in late-onset FPIES (67.7 pg/mL vs. 12.5 pg/mL, p < 0.01), and showed a significant positive correlation with Eo (rs = 0.60, p < 0.01).
Conclusions:
This study demonstrated two types of eosinophilia in Japanese FPIES infants: conspicuous and mild eosinophilia in early- and late-onset FPIES patients, respectively. Conspicuous eosinophilia in early-onset FPIES is suggested to be caused by abnormally high IL-5 production.
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