Evaluation of the Diagnostic Accuracy of Thymus and Activation-Regulated Chemokine to Discriminate Food Protein-Induced Enterocolitis Syndrome from Infectious Gastroenteritis

Makita, Eishi; Kuroda, Sae; Itabashi, Kae; Sugawara, Daisuke; Ichihashi, Ko

doi:10.1159/000510723

Cited by 11 publications

(7 citation statements)

References 9 publications

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“…TARC is a Th2 biomarker used for the diagnosis of atopic dermatitis and in the evaluation of its severity [8]. We recently reported that serum TARC levels were elevated after vomiting in patients with solid food FPIES and that they were correlated with symptomatic severity [5,6]. In this study, we hypothesized that post-emetic TARC levels in egg yolk FPIES could predict the result of an OFC performed with the same amount of egg yolk after a given duration, and evaluated the management of FPIES based on an annual OFC.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…We reported that patients with solid FPIES exhibited higher serum thymus and activation-regulated chemokine (TARC; a Th2 chemokine) levels after vomiting compared to other diseases. Moreover, the post-emetic TARC levels were correlated with symptom severity in FPIES [5,6]. This study evaluated the post-emetic TARC levels, clinical symptoms, and post-index event results of the egg yolk OFC and retrospectively investigated predictive factors for the subsequent OFC result.…”

Section: Introductionmentioning

confidence: 99%

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Potential of Thymus and Activation-Regulated Chemokine (TARC) as a Prognostic Biomarker of Food Protein-Induced Enterocolitis Syndrome (FPIES) Caused by Egg Yolk

Makita

Sugawara

Kuroda

et al. 2022

Int Arch Allergy Immunol

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Background: Several recent studies have reported egg yolk-associated food protein-induced enterocolitis syndrome (FPIES) in Japan. We previously reported the usefulness of post-emetic thymus and activation-regulated chemokine (TARC) levels for the diagnosis and evaluation of symptom severity in FPIES caused by solid foods including egg yolk. However, there are no studies on the usefulness of TARC as a prognostic biomarker. Objective: The aim of the study was to evaluate the post-emetic TARC levels, clinical symptoms, and post-index event results of the egg yolk oral food challenge test (OFC), and retrospectively investigate predictive factors of the subsequent OFC result. Method: This retrospective study included 12 patients with egg yolk FPIES. The following long-term management protocol for egg yolk FPIES was mandatory for study inclusion: Patients visited the emergency department, met the diagnostic criteria of FPIES, and underwent an egg yolk OFC 6–12 months after complete elimination of egg yolk. If the result of the OFC was positive, the patient underwent the OFC every year until it was negative. We analyzed a total of 20 episodes (12 department visits and eight positive OFCs). The blood test data, including post-emetic TARC level and symptom severity, were compared between the next-OFC-positive group and the next-OFC-negative group. In addition, tolerance development over follow-up was analyzed. Results: The median (range) ages of the next-OFC-positive and negative groups were 11 (6–33) and 10 (7–21) months, respectively. The median (range) serum TARC (pg/mL) level was 5,208 (2,009–8,147) in the next-OFC-positive group, which was significantly higher (p = 0.004) than that in the next-OFC-negative group, which was 1,803 (905–3,754). There were no significant differences in other hematological results. The next-OFC-positive group had greater severity compared to the next-OFC-negative group (p = 0.026). The remission rate was approximately 30% at 24 months and 80% at 36 months. Conclusion: Post-emetic TARC levels may predict the short-term prognosis of egg yolk FPIES after approximately 1 year and could be useful for the management of egg yolk FPIES.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential of Thymus and Activation-Regulated Chemokine (TARC) as a Prognostic Biomarker of Food Protein-Induced Enterocolitis Syndrome (FPIES) Caused by Egg Yolk

Makita

Sugawara

Kuroda

et al. 2022

Int Arch Allergy Immunol

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“…46 High levels of the chemokine are seen in patients with food-induced anaphylaxis, 73 gastrointestinal food allergies 74 and childhood allergy development, 75 with elevated CCL17 serum levels reported to be a potential diagnostic biomarker for food protein-induced enterocolitis syndrome, which is a non-immunoglobulin E-mediated gut allergic response. 76 Its tear levels have even been suggested to be a diagnostic biomarker for acute and chronic allergic conjunctival disorders, 77 and atopic and vernal keratoconjunctivitis. 78 These studies again highlight the potential for CCL17 to serve at least as a diagnostic biomarker for numerous diseases.…”

Section: Additional Autoimmune/inflammatory Diseasesmentioning

confidence: 99%

CCL17/TARC in autoimmunity and inflammation—not just a T‐cell chemokine

et al. 2023

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Chemokine (C-C) ligand 17 (CCL17) was first identified as thymus-and activation-regulated chemokine when it was found to be constitutively expressed in the thymus and identified as a T-cell chemokine. This chemoattractant molecule has subsequently been found at elevated levels in a range of autoimmune and inflammatory diseases, as well as in cancer. CCL17 is a C-C chemokine receptor type 4 (CCR4) ligand, with chemokine (C-C) ligand 22 being the other major ligand and, as CCR4 is highly expressed on helper T cells, CCL17 can play a role in T-cell-driven diseases, usually considered to be via its chemotactic activity on T helper 2 cells; however, given that CCR4 is also expressed by other cell types and there is elevated expression of CCL17 in many diseases, a broader CCL17 biology is suggested. In this review, we summarize the biology of CCL17, its regulation and its potential contribution to the pathogenesis of various preclinical models. Reference is made, for example, to recent literature indicating a role for CCL17 in the control of pain as part of a granulocyte macrophage-colony-stimulating factor/CCL17 pathway in lymphocyte-independent models and thus not as a T-cell chemokine. The review also discusses the potential for CCL17 to be a biomarker and a therapeutic target in human disorders.

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“…53 Makita et al reported that blood thymus and activation-regulated chemokine (TARC) levels were higher in FPIES patients visiting the emergency department or conducting OFC than in gastroenteritis or sepsis patients, and that high TARC levels persisted for 6-24 h after the onset of symptoms. 54 They also reported that blood TARC levels at the onset of symptoms in FPIES patients were higher than those in patients with IgE-mediated food allergy at the onset of symptoms, and measuring blood TARC levels in patients presenting to the emergency department with vomiting symptoms may be useful in distinguishing emesis caused by FPIES from vomiting caused by gastroenteritis and IgE-mediated food allergy. 55 However, evaluation of blood TARC level should be conducted with care in patients with eczema because they already have elevated blood TARC levels.…”

Section: Allergen Lymphocyte Stimulation Test (Alst)mentioning

confidence: 99%

Food Protein-induced Enterocolitis Syndrome

Akashi

2023

Keio J. Med.

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Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food allergy. FPIES is characterized by repetitive vomiting without classic IgE-mediated allergic skin or respiratory symptoms 1-4 h after causative food ingestion. The condition may be classified as acute or chronic, typical or atypical, and liquid or solid according to the course of symptoms, presence of IgE antibodies, and causative food, respectively. Since the development of international consensus guidelines in 2017, epidemiological studies have been conducted in many countries. FPIES is a relatively rare disease, with a prevalence of 0.015%-0.7%. However, the number of patients has been increasing in recent years. Most patients develop the disease in infancy. The natural history of FPIES is generally favorable, with most FPIES cases resolving before school age. FPIES is diagnosed using symptoms such as vomiting or diarrhea, or via an oral food challenge (OFC). Currently, no validated biomarker is available for diagnosis, and the mechanisms related to gastrointestinal manifestations and immune system involved in the development of FPIES have not yet been elucidated. Treatment with intravenous fluids and ondansetron is recommended in the acute phase. Long-term management consists of complete causative food elimination and periodic OFC to confirm tolerance. Given that many diagnoses are delayed because of a lack of awareness of the condition, FPIES must be widely recognized by healthcare providers. In the future, it is expected that FPIES pathogenesis will be further clarified, and more objective diagnostic criteria will be developed.

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Evaluation of the Diagnostic Accuracy of Thymus and Activation-Regulated Chemokine to Discriminate Food Protein-Induced Enterocolitis Syndrome from Infectious Gastroenteritis

Cited by 11 publications

References 9 publications

Potential of Thymus and Activation-Regulated Chemokine (TARC) as a Prognostic Biomarker of Food Protein-Induced Enterocolitis Syndrome (FPIES) Caused by Egg Yolk

Potential of Thymus and Activation-Regulated Chemokine (TARC) as a Prognostic Biomarker of Food Protein-Induced Enterocolitis Syndrome (FPIES) Caused by Egg Yolk

CCL17/TARC in autoimmunity and inflammation—not just a T‐cell chemokine

Food Protein-induced Enterocolitis Syndrome

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