Late onset reactions to oral food challenge are linked to low serum interleukin-10 concentrations in patients with atopic dermatitis and food allergy

Authors

  • Sütas,

    1. 0 Department of Paediatrics, University of Turku, Turku, *1 Department of Dermatology, University of Tampere Medical School, Tampere, Finland
    Search for more papers by this author
  • Kekki,

    1. 0 Department of Paediatrics, University of Turku, Turku, *1 Department of Dermatology, University of Tampere Medical School, Tampere, Finland
    Search for more papers by this author
  • and * Isolauri

    1. 0 Department of Paediatrics, University of Turku, Turku, *1 Department of Dermatology, University of Tampere Medical School, Tampere, Finland
    Search for more papers by this author

Dr Isolauri University of Turku, Department of Paediatrics, 20520, Turku, Finland.

Abstract

Background

Aberrant cytokine production in vitro has been associated with atopic disease. No study has as yet been made of the circulating cytokine profiles in atopic patients with food allergy in response to oral allergen challenge.

Objective

To assess the effect of oral allergen challenge on the serum cytokine concentrations in patients with atopic dermatitis and food allergy.

Methods

Serum concentrations of interleukin (IL)-10, transforming growth factor beta 1, IL-1ra, IL-6, IL-5, IL-4 and interferon (IFN)-γ were measured before and after double-blind, placebo-controlled food challenges (DBPCFC) (n = 73). Before DBPCFC, combined skin prick and patch testing was performed for cow milk, egg, soybean and cereals, and production of IFNγ, IL-4, IL-10 and tumour necrosis factor alpha (TNFα) was determined in supernatants of cultures of peripheral blood mononuclear cells (PBMCs) stimulated by cow milk.

Results

The oral food challenge triggered immediate onset exanthematous reactions in 22 cases and late onset eczematous reactions in 29. The late-reacting cases had more positive skin patch test and negative skin prick test reactivities with allergenic food, and they had lower serum IL10 concentrations than immediate-reacting cases. In challenge-positive cases, IL-10 concentrations increased from 2.9 (0.1–5.04) pg/mL to 3.9 (1.2–8.3) pg/mL in response to DBPCFC, P = 0.05, median (interquartile ranges), but not in those tolerant to cow milk. PBMCs of patients with cow milk allergy but not of those tolerant to cow milk generated TNFα in response to cow milk in vitro.

Conclusion

These results indicate that oral allergen challenge in atopic patients with food allergy triggers systemic release of IL-10. Patients with late onset reactions were found to have lower serum IL-10 concentrations than their immediate-reacting counterparts. Considering that IL-10 is an inhibitory cytokine of delayed-type hypersensitivity, low IL-10 in late-reacting patients may explain the high frequency of their positive skin patch tests combined with negative skin prick tests.

Ancillary