Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome

Abstract

CME 317 Review www.expert-reviews.com ISSN 1744-666X © 2011 Expert Reviews Ltd 10.1586/ECI.11.13 Jean-Christoph Caubet1,2 and Anna Nowak-Węgrzyn†1 1Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Mount Sinai School of Medicine, New York, NY, USA 2University Hospitals of Geneva and Medical School of the University of Geneva, Department of Child and Adolescent, Geneva, Switzerland †Author for correspondence: Tel.: +1 212 241 5548 Fax: +1 212 426 1902 anna.nowak-wegrzyn@mssm.edu Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized and frequently misdiagnosed non-IgE-mediated food hypersensitivity disorder, characterized by severe vomiting and/or diarrhea. Despite the potential severity of acute reactions, FPIES can be considered self-limiting as avoidance of the incriminating allergen(s) leads to resolution of symptoms. Symptoms typically begin in the first month of life in association with failure to thrive and may progress to acidemia and shock. Although FPIES is well established as a distinct clinical entity, its pathophysiology has not yet been clearly defined and requires further characterization. Several immunologic alterations have been reported in FPIES, suggesting the involvement of antigen-specific T cells and their production of proinflammatory cytokines that regulate the permeability of the intestinal barrier. Humoral immune responses may also be involved in the pathomechanism of FPIES. The aim of this article is to delineate the immunological characteristics of this disorder based on the existing reports and to review the possible pathophysiologic basis of this disease. Keywords: allergy • food • food allergy • food protein-induced enterocolitis syndrome • FPIES • humoral immunity • mechanism • pathophysiology • T cells • TGF-b • TNF-a Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome Expert Rev. Clin. Immunol. 7(3), 317–327 (2011) Learning objecti