Food protein–induced enterocolitis syndromes with and without bloody stool have distinct clinicopathologic features Hideaki Morita, MD, PhD, Hiroko Suzuki,

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Presentation transcript:

Food protein–induced enterocolitis syndromes with and without bloody stool have distinct clinicopathologic features Hideaki Morita, MD, PhD, Hiroko Suzuki, MD, PhD, Kanami Orihara, PhD, Kenichiro Motomura, MD, Akio Matsuda, PhD, Yukihiro Ohya, MD, PhD, Hirohisa Saito, MD, PhD, Ichiro Nomura, MD, PhD, Kenji Matsumoto, MD, PhD Journal of Allergy and Clinical Immunology Volume 140, Issue 6, Pages 1718-1721.e6 (December 2017) DOI: 10.1016/j.jaci.2017.06.002 Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Milk protein-specific lymphocyte proliferation and cytokine production in patients with FPIESwBS and FPIESnoBS. PBMCs from each patient were stimulated separately with each of 5 different milk proteins (α-lactalbumin, β-lactoglobulin, α-casein, β-casein, and κ-casein). The data show the highest concentration of each cytokine or the highest proliferation detected in response to each stimulus. The stimulation index was calculated as milk protein-induced 3H-thymidine uptake (cpm)/vehicle-induced 3H-thymidine uptake (cpm). A, Proliferation and IL-2 levels. B, TNF-α, IL-6, and IL-1β levels. C, IL-4, IL-5, and IL-13 levels. D, IL-10, IFN-γ, and IL-17 levels. Each dot represents data from 1 patient, and medians are shown. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2017 140, 1718-1721.e6DOI: (10.1016/j.jaci.2017.06.002) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Kaplan-Meier plot for cumulative probability of cow's milk tolerance in patients with FPIES. FPIESwBS (solid line) and FPIESnoBS (dotted line). Twenty-nine patients with FPIES (FPIESwBS, n = 21; FPIESnoBS, n = 8) were followed for ≤38 months until they showed tolerance to milk ingestion. Journal of Allergy and Clinical Immunology 2017 140, 1718-1721.e6DOI: (10.1016/j.jaci.2017.06.002) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Microscopic bloody stools seen in patients with FPIESwBS. Journal of Allergy and Clinical Immunology 2017 140, 1718-1721.e6DOI: (10.1016/j.jaci.2017.06.002) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Responses to each milk protein component. PBMCs from children with FPIES were stimulated separately with 100 μg/mL of each of 5 LPS-depleted cow's milk protein preparations. A, The stimulation index was calculated as milk protein-induced 3H-thymidine uptake (cpm)/vehicle-induced 3H-thymidine uptake (cpm). B, The cytokine production profiles were measured by multiplex assay or ELISA. Each dot represents data from 1 patient, and medians are shown. *P < .05, **P < .01, and ***P < .001. Journal of Allergy and Clinical Immunology 2017 140, 1718-1721.e6DOI: (10.1016/j.jaci.2017.06.002) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Correlation among cytokines in culture supernatants. PBMCs from children with FPIES were stimulated separately with 100 μg/mL of each of 5 LPS-depleted cow's milk protein preparations in the presence of 5% autologous plasma for 6 days. The concentration of IL-13 in the culture supernatants correlated significantly with the concentrations of IL-5 and IL-10, but not with the concentration of TNF-α. Journal of Allergy and Clinical Immunology 2017 140, 1718-1721.e6DOI: (10.1016/j.jaci.2017.06.002) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions