Identification of gut biomarkers of FPIES in a longitudinal comparative
pediatric study
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.