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Introduction: We previously reported that thymus and activation-regulated chemokine (TARC) levels measured after vomiting are useful predictors of a food protein-induced enterocolitis syndrome (FPIES) diagnosis. However, interpreting TARC levels in patients with eczema is difficult, as the levels are similarly elevated in patients with eczema caused by atopic dermatitis (AD). Therefore, we aimed to investigate whether it is possible to predict whether FPIES or AD is responsible for elevated TARC levels by simultaneously measuring TARC and squamous cell carcinoma antigen 2 (SCCA2), another T-helper type 2 biomarker. Methods: Twenty-one episodes in 11 patients with FPIES (FPIES group) and 42 age-matched patients with AD (AD group) were included in this study. Serum TARC and SCCA2 levels were measured, and those values and relative ratios were compared between groups. Results: The median age was 1.1 years in the FPIES group and 1.6 years in the AD group (p = 0.492). The median (interquartile range [IQR]) serum TARC concentration was significantly higher in the FPIES group than in the AD group (2,486 [1,815–4,097] pg/mL and 1,451 [1,201–1,751] pg/mL, respectively; p = 0.002). The median (IQR) SCCA2 concentration was significantly higher in the AD group than in the FPIES group (1.9 [1.3–2.9] pg/mL and 0.8 [0.6–1.5] pg/mL, respectively; p < 0.001). After matching, the analysis using stratified TARC values revealed no significant difference in TARC values between the FPIES and AD groups; however, the TARC/SCCA2 ratio was significantly higher in the FPIES group. Conclusion: Assessing the relative TARC/SCCA2 ratio may help predict whether elevated TARC levels measured after vomiting are caused by FPIES or AD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Patients with food protein-induced enterocolitis syndrome (FPIES) have elevated thymus and activation-regulated chemokine (TARC) levels in the acute phase. However, to the best of our knowledge, no study has evaluated TARC levels in the acute phase of immunoglobulin E-dependent food allergy (IgE-FA). If TARC elevation is a specific response to FPIES among FAs, TARC measurement may help distinguish between FPIES and IgE-FA. Thus, we investigated acute phase TARC levels in patients with FPIES and IgE-FA. Methods: Thirty-one episodes in 16 patients with FPIES and 20 episodes (13 were anaphylaxis) in 20 patients with IgE-FA were included. Patients with eczema were excluded. Serum TARC levels within 6 h of allergic reaction onset and age-adjusted TARC ratios (TARC levels divided by age-specific normal TARC values) were compared between the groups. Results: The median age was 1.1 and 3.6 years in the FPIES and IgE-FA groups, respectively (P < 0.001). The median (range) serum TARC (pg/mL) levels were significantly higher in the FPIES group than in the IgE-FA group [1,283 (410–3,821) versus 377 (109–1,539); P < 0.001]. The median (range) age-adjusted TARC ratios were also significantly higher in the FPIES group [2.56 (0.57–7.86) versus 1.08 (0.15–2.17); P < 0.001]. The area under the curve (AUC) for TARC to distinguish FPIES from IgE-FA was 0.926, and the AUC for the age-adjusted TARC ratio was 0.850. The odds ratio for FPIES diagnosis per 1,000 pg/mL increase in TARC was 31.6 (P = 0.002), and the odds ratio adjusted by age was 17.1 (P = 0.016). Conclusion: Acute phase TARC levels were higher in patients with FPIES than in patients with IgE-FA. The increase in acute phase TARC levels was considered to be a specific response to FPIES among FAs. Measurement of TARC levels in the acute phase may help differentiate FPIES from IgE-FA. [ABSTRACT FROM AUTHOR]

CRP, C-reactive protein; FPIES, food protein-induced enterocolitis syndrome; TARC, thymus and activation-regulated chemokine; WBC, white blood cell count gl Table S2 shows the results when the control group was divided into infectious gastroenteritis and sepsis patients and compared with FPIES patients. Nonetheless, there was a significant difference in the TARC levels between patients with FPIES and the controls, indicating that TARC level elevation is specific to FPIES. Patients with cow's milk FPIES or chronic FPIES were excluded. Since there were no test items that reflect FPIES severity, we expect that the TARC value after vomiting may be used as an objective evaluation item for FPIES severity. [Extracted from the article]

Background: Post-emetic elevation in thymus and activation-regulated chemokine (TARC) levels has been reported in patients with food protein-induced enterocolitis syndrome (FPIES); however, no studies have investigated differences in TARC levels between FPIES and other diseases. Objectives: We evaluated the clinical usefulness of TARC measurement in differentiating between FPIES and infectious gastroenteritis. Methods: This study included 8 patients with solid-food FPIES (FPIES group; hen's egg [n = 6], rice [n = 1], and short-neck clam [n = 1]; a total of 11 episodes necessitating emergency department visit or positive result of oral food challenge test) and 17 patients with infectious gastroenteritis (control group), and all patients had no eczema. Post-emetic serum TARC levels and modified TARC levels (serum TARC value – normal mean for each age) were compared between the 2 groups. Results: The median (range) ages for the FPIES and control groups were 0.7 (0.5–6.2) and 1.8 (0.1–4.4) years, respectively (p > 0.05). In the FPIES and control groups, median (range) TARC levels were 2,911 (1,062–7,816) and 600 (277–2,034) pg/mL, and median (range) modified TARC levels were 2,204 (355–7,109) and 129 (0–1,314), respectively. The TARC and modified TARC levels were significantly higher in the FPIES group than in the control group (p < 0.001 for both). Conclusion: In the absence of eczema, post-emetic serum TARC levels might be a potential diagnostic biomarker for distinguishing FPIES from infectious gastroenteritis. [ABSTRACT FROM AUTHOR]

Background: The modified pulmonary index score (mPIS) is reported to be useful for assessing bronchial asthma severity. However, mPIS has not been compared with other scores to date. In this study, we have compared mPIS with other scores and clarified the usefulness of mPIS. Materials and Methods: The study assessed children (n = 67; median age = 3 years) hospitalized for acute exacerbation of bronchial asthma without pneumonia between April 2016 and August 2017. We evaluated mPIS, pulmonary index score (PIS), and modified Wood's Clinical Asthma Score (mWCAS) from their medical record at admission, and we retrospectively evaluated the correlation between each score and clinical outcomes. Results: The median values for mPIS, PIS, and mWCAS were 9, 7, and 3, respectively. The median durations of hospitalization and of systemic glucocorticosteroid therapy were 7 and 4 days, respectively; 27 patients (40.2%) received continuous inhalation therapy with isoproterenol. All the scores were moderately positively correlated with the duration of hospitalization as follows: mPIS, 0.566 (P < 0.001); PIS, 0.488 (P < 0.001); and mWCAS, 0.411 (P < 0.001). Moderate positive correlations were observed between all scores and the duration of systemic glucocorticosteroid therapy as follows: mPIS, 0.488 (P < 0.001); PIS, 0.407 (P < 0.001); and mWCAS, 0.367 (P = 0.002). Receiver operating characteristic curve analysis of need for continuous inhalation therapy with isoproterenol yielded areas under the curve of 0.91, 0.83, and 0.87 for mPIS, PIS, and mWCAS, respectively. Conclusions: Correlation of mPIS and outcome was equal to or stronger than that of PIS or mWCAS, and mPIS can be useful for assessing the severity of acute exacerbations of bronchial asthma and predicting prognosis. [ABSTRACT FROM AUTHOR]