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Identification of gut biomarkers of FPIES in a longitudinal comparative pediatric study
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  • Anaïs Lemoine,
  • Nathalie Kapel,
  • Ioannis Nicolis,
  • Patrick Tounian,
  • Aurelia Bruneau,
  • Kapandji N,
  • K Adel-Patient,
  • Thomas M
Anaïs Lemoine
Microbiologie de l'Alimentation au Service de la Sante

Corresponding Author:[email protected]

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Nathalie Kapel
Assistance Publique - Hopitaux de Paris
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Ioannis Nicolis
Universite Paris Cite
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Patrick Tounian
Assistance Publique - Hopitaux de Paris
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Aurelia Bruneau
Microbiologie de l'Alimentation au Service de la Sante
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Kapandji N
Microbiologie de l'Alimentation au Service de la Sante
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K Adel-Patient
Commissariat a l'energie atomique et aux energies alternatives Centre de Saclay
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Thomas M
Microbiologie de l'Alimentation au Service de la Sante
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Abstract

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy without known biomarkers. We aimed to compare fecal biomarkers related to gut inflammation and immunity in children with FPIES, with resolved FPIES (tolerant), and in matched controls. Methods: Stools were collected from FPIES children on elimination diet, before and after an oral food challenge (OFC) performed to assess their natural tolerance, at the end of a follow-up in tolerant FPIES children, and in matched controls (1:1 ratio). Concentrations of calprotectin, EDN (eosinophilic derived neurotoxin), and secretory IgA (sIgA) underwent comparative paired analysis. Results: Thirty-eight patients were included (age: 1.3 years old, interquartile range: IQR [0.9 - 2.0]), of which 22 became tolerant during follow-up. Upon inclusion, allergic patients and controls had similar concentrations of calprotectin (38µg/g [8-85] vs 27µg/g [11-46], p=0.15) and EDN (504ng/g [275-1252] vs 516ng/g [215-844], p=0.86). However, concentrations of these inflammatory biomarkers increased transiently after a failed OFC (p<0.001 and p=0.01 respectively), without correlating with the severity of an allergic reaction. sIgA were higher in allergic than in tolerant patients: 2224µg/g [878-3529] vs 794µg/g [699-1767] (p<0.01). Calprotectin, EDN, and sIgA were comparable in tolerant patients and controls. sIgA less than 2637µg/g had a negative predictive value of 75.6% for the differentiation allergic patients from tolerant patients and controls (area under curve: 0.63, 95% CI: 0.52–0.74). Conclusion: A few days after an acute allergic reaction, there was no detectable chronic gut inflammation in FPIES. sIgA may be a useful tool for clinicians in timing OFC.
Submitted to Allergy
Assigned to Editor
Reviewer(s) Assigned
Submission Checks Completed
28 Jun 2024Reviewer(s) Assigned
11 Jul 2024Review(s) Completed, Editorial Evaluation Pending
15 Jul 2024Editorial Decision: Revise Minor