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To the Editor: Food protein-induced enterocolitis syndrome (FPIES) causes vomiting several hours after causative food’s ingestion, and its reactions often improve several hours compared with the usual several-day time course of gastroenteritis [1]. Diagnosis of FPIES often requires multiple episodes. If only a single episode has occurred, an oral food challenge (OFC) is recommended [1]. Because OFCs may induce strong symptoms, markers that can diagnose FPIES at the first episode without OFCs are desirable.
Case 1 A 5-mo-old boy without atopic dermatitis (AD) was admitted to our hospital due to vomiting. Approximately 3 h before he began vomiting, he had drunk milk for the first time since being discharged from the maternity hospital; therefore, we suspected FPIES due to milk. His symptoms improved after several hours. The next-day thymus and activation-regulated chemokine (TARC) was as high as 5503 pg/mL. One month later, he vomited 3 h after a milk challenge test. Thus, he was diagnosed with FPIES due to milk.
Case 2 A 7-mo-old boy without AD was admitted to our hospital due to vomiting. He had ingested egg yolk 3 h before he began vomiting. We suspected FPIES due to egg yolk, which has recently become more common in Japan [2]. His symptoms improved after several hours. The next-day TARC was as high as 5278 pg/mL. Two months later, he vomited 3 h after egg yolk ingestion. Thus, he was diagnosed with FPIES due to egg yolk.
TARC, which is a chemokine inducing Th2 response, is a marker reflecting the disease activity of AD [3]. TARC has also been reported to increase 24 h after causative foods ingestion in FPIES [4]. If infants vomit several hours after eating foods likely to cause FPIES and those symptoms improve faster compared to gastroenteritis, the next-day TARC may be a strong indicator of FPIES.
References
Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-workgroup report of the adverse reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139:1111–26.e4.
Akashi M, Hayashi D, Kajita N, et al. Recent dramatic increase in patients with food protein-induced enterocolitis syndrome (FPIES) provoked by hen’s egg in Japan. J Allergy Clin Immunol Pract. 2022;10:1110–12.e2.
Renert-Yuval Y, Thyssen JP, Bissonnette R, et al. Biomarkers in atopic dermatitis—a review on behalf of the International Eczema Council. J Allergy Clin Immunol. 2021;147:1174–90.e1.
Okura Y, Shimomura M, Takahashi Y, Kobayashi I. Usefulness of thymus and activation-regulated chemokine in solid food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. 2022;33:e13677.
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Fujita, Y., Yoshihara, S. Utility of Thymus and Activation-Regulated Chemokine for Diagnosing Food Protein-Induced Enterocolitis Syndrome at the First Episode. Indian J Pediatr 90, 524 (2023). https://doi.org/10.1007/s12098-023-04512-0
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DOI: https://doi.org/10.1007/s12098-023-04512-0