Supplementary Material for: Wheat food protein-induced enterocolitis syndrome in celiac children on gluten free diet: A new clinical association.

Introduction: The association between food protein-induced enterocolitis syndrome (FPIES) and wheat ingestion in children with celiac is unknown at this time. Methods: We present seven cases of children with celiac who presented with symptoms of wheat-triggered acute FPIES (a-FPIES). An oral food challenge (OFC) with wheat allergen followed by 4 hours of observation were performed. Activation of innate system cells were measured at baseline (T0), during symptoms (Ts) and 4 hours after symptom onset (Ts+4). A panel of human inflammatory cytokines was also performed. Results: All patients reacted to the first allergen dose. Three patients experienced a decrease of 30 mm Hg in systolic blood pressure and tachycardia and required hemodynamic resuscitation. Neutrophilia and a decrease in eosinophil count were evident at 4 hours after symptom onset. At 4 hours after symptom onset, cytokines (IL-6 and IL-8, and to a lesser degree, IL-10) were elevated. Conclusion: In a small sample of celiac patients with wheat exposure in an OFC, symptoms and acute immunological changes in serum inflammatory cytokine profile were consistent with a-FPIES.