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Clinical and Developmental Immunology
Volume 2009, Article ID 679381, 4 pages
Case Report

Cytokine Expression in CD3+ Cells in an Infant with Food Protein-Induced Enterocolitis Syndrome (FPIES): Case Report

1Allergy and Clinical Immunology Unit, Department of Pediatrics, Meyer Children Hospital, University of Florence, 50122 Florence, Italy
2Allergy and Immunology Division, University of Pennsylvania, The Philadelphia Children's Hospital, Philadelphia, PA 19104, USA
3Clinic of Infectious Diseases, Department of Pediatrics, Meyer Children Hospital, University of Florence, 50122 Florence, Italy

Received 28 April 2009; Revised 10 July 2009; Accepted 1 September 2009

Academic Editor: Kurt Blaser

Copyright © 2009 F. Mori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by severe vomiting, diarrhea, and often failure to thrive in infants. Symptoms typically resolve after the triggering food-derived protein is removed from the diet and recur within few hours after the re-exposure to the causal protein. The diagnosis is based on clinical symptoms and a positive food challenge. In this study, we report a case of FPIES to rice in an 8-month-old boy. We performed a double-blind placebo-controlled food challenge (DBPCFC) to rice and we measured the intracellular T cell expression of interleukin-4 (IL-4); IL-10, and interferon 𝛾 (IFN- 𝛾 ) pre-and post-challenge during an acute FPIES reaction and when tolerance to rice had been achieved. For the first time we describe an increase in T cell IL-4 and decrease in IFN- 𝛾 expression after a positive challenge with rice (i.e. rice triggered a FPIES attack) and an increase in T cell IL-10 expression after rice challenge 6 months later after a negative challenge (i.e., the child had acquired tolerance to rice) in an 8 month old with documented FPIES to rice. A Th2 activation associated with high IL-4 levels may contribute to the pathophysiology of the disease. On the other hand, T cell-derived IL-10 may play a role in the acquisition of immunotolerance by regulating the Th1 and Th2 responses.