Atypical FPIES?

I am learning more of Little Man's specific allergic responses from the blood tests data done through Dr.Jyonouchi at the PCRCD.   The blood tests give us a "snapshot" of what is happening in his body, in response to 3 food proteins and a gut microbe (Candida).   Little Man shows little reactivity of IFN-g and TNF-a to these foods, but he does show reactivity to Candida; he also shows high reactivity at the IL-17, as well as IL-12 responses.   His counter regulatory mechanisms of IL-10 and TGF-b are askew as well to all antigens tested, inappropriately high for such little response at the IFN-g and TNF-a levels.   

I have learned that IFN-g and TNF-a are specific Th1 responses, which are the bodies response to invaders, bacteria that protect our bodies with immune responses.  In a fine-tuned body, these responses go primarily un-noticed.  But, in FPIES, these responses are uncontrolled as the body launched these against food.  Seeing that Little Man has little response at this level but does produce counter-regulatory mechanism (high) tells us that his FPIES is atypical.  But we already knew that....now we have a glimpse to why...

Th17 is a newly discovered Thelper cell.   It is part of the GALT (gut associated lymphoid tissue).   It is an alternative back-door to the Th1 response, through the gut.   It can be controlled, or further exacerbated by the gut environment.   One of Little mans worst reactions is to his own gut flora, Candida.  He has severe dysbiosis and it is causing "leaky gut" which is causing him to build Th17 responses to every protein as the body is presenting these antigens in a dysregulated mechanism...likely due to his gut dysbioisis.   If we can correct his dysbiosis, heal his "leaky gut", we increase his body's ability to regulate itself in respect to foods and the immune responses.   Refer to my FPIES File Cabinet for a post on Leaky Gut.

Where do we start?   We begin by removing all his allergens.   Moving from formula to hemp milk many months ago accomplished this; but this move hasn't been without it's side effects.   While this diet provided him with a safe nourishment of calories/protein/fats, it has not helped correct his dysbiosis.   The missing micronutrients and diverse source of nutrients likely have made it more difficult for his body to maintain any homeostasis achieved, even with daily probiotics.  

1. Remove allergens. 
2. Provide nutrition.  
3. Promote healing. 
4. Correct dysbiosis and achieve gut homeostasis.

We are stuck in the dysbiosis and healing stages.   We have healed his intestinal tract but there is more to healing the intestinal health than healing inflammation.   We have clearly not healed his leaky gut or achieved gut homeostasis.  

Going to the PCRCD gave us the confirmations of his severe dysbiosis, and his atypical FPIES.  But now what?   We are working our way through probiotics, we are getting stool studies done, and then we hit bumps in the road and everything comes to a halt, and even go backwards.    The Vicious cycle continues...