Increased serum cortisol on oral food challenge in infants with food protein‐induced enterocolitis syndrome

• Published in: Pediatrics international Vol. 60; no. 1; pp. 13 - 18
• Main Authors: Shimomura, Masaki, Ito, Yasunori, Tanaka, Hiroki, Meguro, Takaaki, Kimura, Mitsuaki
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.01.2018
• Subjects: Biomarkers - blood; Case-Control Studies; Cortisol; Cow's milk; Enterocolitis; Enterocolitis - blood; Enterocolitis - diagnosis; Enterocolitis - etiology; eosinophil; Female; Food; food protein‐induced enterocolitis syndrome; Hormones; Humans; Hydrocortisone - blood; Infant; Infant, Newborn; Infants; Interleukin 8; Interleukin-8 - blood; Male; Milk Hypersensitivity - blood; Milk Hypersensitivity - complications; Milk Hypersensitivity - diagnosis; Milk Proteins - adverse effects; neutrophil; Neutrophils; Neutrophils - metabolism; Pediatrics; Syndrome; Vomiting; cortisol; eosinophil; interleukin-8; neutrophil; food protein-induced enterocolitis syndrome
• ISSN: 1328-8067; 1442-200X; 1442-200X
• DOI: 10.1111/ped.13449

Background An increase in absolute neutrophil count (ANC) is seen after oral food challenge test (OFC) in patients with food protein‐induced enterocolitis syndrome (FPIES). Although it has been suggested that interleukin (IL)‐8 is involved in this phenomenon, a possible role for cortisol has not yet been studied. Methods Six positive OFC in five patients with FPIES due to cows’ milk (CM) proteins, and two negative OFC in two patients with suspected FPIES were analyzed. Absolute neutrophil count, serum IL‐8, and serum cortisol were measured before OFC, 6 and 24 h after the ingestion of CM formula. Results For the positive OFC, ANC measured 6 h after the ingestion of CM formula was significantly higher than that measured before the OFC (median, 8,761 versus 2,297/μL; P < 0.05). Significant increases in serum cortisol and IL‐8 were observed 6 h after OFC (cortisol, median 1,119 pg/mL before versus 2,141 pg/mL after, P < 0.05; IL‐8, median 15.5 pg/mL before versus 165.3 pg/mL after, P < 0.05). The change ratio (i.e. ratio of that after OFC to that before OFC) of ANC was significantly correlated not only with that of serum IL‐8 (r = 0.90, P < 0.01) but also with that of serum cortisol (r = 0.76, P < 0.05). Moreover, the serum cortisol change ratio was significantly higher in subjects with vomiting than in those without (median, 2.5 versus 1.0, P < 0.05). Conclusions Serum cortisol, in combination with IL‐8, affects the increase in ANC after OFC.