Diagnosis of Food Protein-Induced Enteropathy Based on Gastrointestinal Mucosal Pathology before and after Elimination Diet Therapy: A Case Report
Round 1
Reviewer 1 Report
Comments for author File: 
Comments.pdf
Author Response
Point-by-point responses to reviewer’s comments
Response to Reviewer #1
Page2, Line65; Most cases of FPE are often relieved with hydrolyzed milk and elemental diets. However, in this case, the symptoms did not improve with an elemental diet. Are you sure this case is suitable for FPE?
Response: Thank you for your comment. Accordingly, we have added an explanation for this point in the Discussion section (lines 187–190).
Page2, Line73; FPE has gastrointestinal malabsorption due to villous atrophy and often presents with hypoproteinemia. Why does the laboratory data in this study contradict that?
Response: Thank you for your comment. Her total protein and albumin levels were slightly low, which was possibly because of intravenous drip replenishment. We have added an explanation for this point in the Case Report section (lines 70–71).
Page4, Line155; The histological findings give the impression that there is more eosinophil infiltration than indicated. If this case is an eosinophilic gastrointestinal disease, we feel that the histology of this case is more characteristic of an eosinophilic gastrointestinal disease, although some cases are known to respond to food elimination and the histological findings improve.
Response: Thank you for your comment. EGID was considered among the differential diagnoses; however, a diagnosis of FPE was finally suspected based on the characteristics of the gastrointestinal mucosa, such as atrophy of small intestinal mucosal villi, crypt hyperplasia, eosinophil infiltration below the EGID diagnostic criteria (<20 eos/hpf), and lymphocyte infiltration (lines 102–106). We have revised “<10 eos/hpf” to “<20 eos/hpf” throughout the manuscript.
Reviewer 2 Report
Dear authors,
Thank you for providing this case report.
The investigations are clearly explained. This case report reminds me to several similar cases in my institution.
I have just two suggestions/remarks
1. Did this child experience any side effects from long term treatment with corticoids such as hypertension, etc ...Please consider mentioning this in the text
2. Page 2. Line 73. Please consider modifying wording from aspartic aminotransferase to aspartate aminotransferase
Wish you all the best in the publication process and congratulations
Best regards
Reviewer
Author Response
Point-by-point responses to reviewer’s comments
Response to Reviewer #2
- Did this child experience any side effects from long term treatment with corticoids such as hypertension, etc...Please consider mentioning this in the text.
Response: Thank you for your comment. We have added details about any side effects accordingly (lines 110).
- Page 2. Line 73. Please consider modifying wording from aspartic aminotransferase to aspartate aminotransferase.
Response: Thank you for your comment. We have revised the term accordingly (lines 66).
Reviewer 3 Report
This is a very interesting case report.
I appreciated the presentation and the novelty introduced.
Just check some minor typos
Author Response
Point-by-point responses to reviewer’s comments
Response to Reviewer #3
This is a very interesting case report. I appreciated the presentation and the novelty introduced. Just check some minor typos.
Response: Thank you for your evaluation for our manuscript. The manuscript has been carefully reviewed by an experienced editor whose first language is English and who specializes in editing papers written by scientists whose native language is not English.
Round 2
Reviewer 1 Report
We believe that all questions have been responded and that publication is appropriate.
