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Response to Drs Gordon and Clark

Journal of Perinatology volume 31, pages 298–299 (2011)Cite this article

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We appreciate the interest shown in our case report and the comments of Drs Gordon and Clark.1 Gordon and Clark provide very interesting findings from the largest dataset of preterm infants with necrotizing enterocolitis (NEC) and their eosinophil counts at the time of the NEC diagnosis. In their dataset, in addition to the lack of feeding history (pathogenesis of allergic colitis is driven by dietary antigens), it is not clear whether stool examination for leucocytes was done in the subset of NEC patients categorized based on peripheral eosinophil count. The supposition about the allergic enterocolitis as a benign entity compared to NEC in general is based on lack of reported mortality rates in neonatal literature attributed to allergic enterocolitis as a clinical entity in itself and the dramatic improvement and non-progression of systemic symptomatology with removal of offending dietary antigen. Although a mortality rate of 16.8% relative to the higher mortality rate of 22% between low (<10) eosinophil count and higher eosinophil count (⩾10) groups with NEC may appear important, for a condition thought to be benign, even 16.8% mortality may be considered high by many in neonatal practice, if this subset were to truly represent allergic enterocolitis.

Of the three cytokines, interleukin-3 (IL-3), interleukin-5 (IL-5) and granulocyte–macrophage colony-stimulating factor (GM-CSF), IL-5 (also known as differentiation–differentiation factor) is recognized as the most specific for the eosinophil lineage and responsible for selective differentiation of eosinophils.2 However, correlation of serum concentrations of IL-5 and GM-CSF with the degree of severity of eosinophilia was not observed in the preterm neonates with eosinophilia in infection or necrotizing enterocolitis.3 It is possible that IL-5 may be responsible for high eosinophilia in allergic enterocolitis as described in allergic conditions.2

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References

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  1. Department of Pediatrics, New York Hospital Queens, Flushing, NY, USA

    P Srinivasan & M Brandler

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  1. P Srinivasan
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  2. M Brandler
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Correspondence to P Srinivasan.

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Srinivasan, P., Brandler, M. Response to Drs Gordon and Clark. J Perinatol 31, 298–299 (2011). https://doi.org/10.1038/jp.2010.195

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