miRNA expression profiles in peripheral blood from 29 children with OFC-confirmed moderate-to-severe FPIES were analyzed at three timepoints (baseline, reaction onset, and 4 hours post-reaction) and compared to profiles from 26 children with acute gastroenteritis (AGE) or sepsis to identify FPIES-specific diagnostic biomarkers and regulatory pathways.
A 2-miRNA diagnostic signature distinguished FPIES from sepsis and AGE with AUC=0.98; 26 miRNAs total were validated as differentiators, miRNA-29a correlated with reaction severity, and in silico analysis implicated TGF-β signaling and T-cell differentiation pathways.
Small sample size (29 FPIES, 26 controls) limits generalizability; pathway findings are in silico and require experimental validation; single-center or restricted cohort design may not capture full FPIES heterogeneity across triggers and populations.
While not yet ready for clinical use, a blood-based 2-miRNA signature (AUC=0.98) shows strong potential as a non-invasive diagnostic tool that could eventually reduce reliance on risky oral food challenges in children with suspected FPIES.
