Clinical and immunological characteristics of a pediatric population with food protein-induced XXXX (FPIES) to fish.

@entity1 @entity1697 @entity310 @entity566 @entity391 @entity1964
BACKGROUND: Food protein-induced @entity1964 (FPIES) is an uncommon, non-IgE mediated food @entity566 that usually debuts in @entity391 , lethargy and pallor 2-4 hours following ingestion of the offending food. Its immune mechanism is not known. We aimed to describe the clinical features and outcome of @entity1 with fish-FPIES as well as to investigate on cellular immune response implicated. METHODS: Prospective and follow-up clinical study of @entity1 with FPIES by fish over a period between 2004-2013. Measurement in vitro of both cytokine production in peripheral blood mononuclear cells (PBMCs) and expression of HLA-DR in monocyte-derived dendritic cells, stimulated with fish extracts. RESULTS: Sixteen @entity1 (seven male and nine female) were included, with a mean age of onset at 10 months. Diagnosis was established after a median of 4 reactions. Twelve @entity1 were treated in emergency room, and two were admitted in intensive care. Patch tests were positive in six @entity1 . Skin prick tests (SPTs) and specific IgE to all fish tested were negative. Only three @entity1 reached tolerance at a mean age of 4.5 years. Eight @entity1 avoided fish because of positive @entity1697 ( @entity1697 ) after 6 years of age. Other @entity1 have not been challenged because of parent refusal to @entity1697 or a recent diagnosis. @entity310 was increased in @entity1 and a significant elevation of the HLA-DR marker was also observed in these @entity1 vs control donors. CONCLUSIONS: FPIES caused by fish in many cases presents with severe clinical manifestations. Patch test has poor diagnostic value and @entity1697 is the gold standard to test tolerance. The cytokine @entity310 may be implicated in the clinical symptoms. Higher expression of HLA-DR in dendritic cells has also been detected in our @entity1 . This article is protected by copyright. All rights reserved.
