Saarinen K M, Suomalainen H, Savilahti E
Hospital for Children and Adolescents, University of Helsinki, PO Box 280, Lastenlinnantie 11 C 29, FIN-00029 HYKS, Helsinki, Finland. kristiina.saarinen@hus,fi
Clin Exp Allergy. 2001 Mar;31(3):423-9. doi: 10.1046/j.1365-2222.2001.01015.x.
The diagnosis of cow's milk allergy is based on a clinical response to an elimination-challenge test with cow's milk. We studied the usefulness of the skin-prick and patch tests and measurement of cow's milk-specific IgE and eosinophil cationic protein in serum as diagnostic tools for cow's milk allergy in a cohort of 6209 unselected infants followed from birth for the development of cow's milk allergy. Of the 239 infants challenged with cow's milk, 118 showed a positive and 121 a negative response at a mean age of 6.9 months. A positive reaction to a skin-prick test with cow's milk (> or = 3 mm) was seen in 72 (61%) and 29 (24%) infants with positive and negative challenges, elevated serum cow's milk-specific IgE (> or = 0.7 kU/L) in 52 (45%) and 15 (13%) infants, a positive reaction to patch test with cow's milk protein fractions in 26 (26%) and eight (8%) infants, and elevated serum eosinophil cationic protein (> or = 20 microg/L) in 22 (21%) and seven (13%) infants, respectively. Parallel use of the four tests with the above-mentioned cut-off values correctly classified 73% of the infants with a sensitivity of 0.76 and a specificity of 0.67. An immediate reaction to cow's milk challenge correlated with skin prick test positivity and elevated serum milk-specific IgE, and tended to correlate with patch test positivity. No single test or parallel use of the four tests could predict the challenge outcome acceptably in this prospectively followed, unselected cohort of 6209 infants. A positive reaction to one or more tests needs to be confirmed by a challenge test and a negative response to all four tests does not rule out the possibility of cow's milk allergy.
牛奶过敏的诊断基于对牛奶进行排除激发试验后的临床反应。我们研究了皮肤点刺试验、斑贴试验以及血清中牛奶特异性IgE和嗜酸性粒细胞阳离子蛋白的检测作为牛奶过敏诊断工具的有效性，研究对象为6209名未经过筛选的婴儿，从出生起就对他们进行跟踪，观察牛奶过敏的发生情况。在239名接受牛奶激发试验的婴儿中，平均年龄6.9个月时，118名反应为阳性，121名反应为阴性。牛奶皮肤点刺试验阳性反应（≥3毫米）在激发试验阳性的婴儿中有72名（61%），激发试验阴性的婴儿中有29名（24%）；血清牛奶特异性IgE升高（≥0.7 kU/L）在激发试验阳性的婴儿中有52名（45%），激发试验阴性的婴儿中有15名（13%）；牛奶蛋白组分斑贴试验阳性反应在激发试验阳性的婴儿中有26名（26%），激发试验阴性的婴儿中有8名（8%）；血清嗜酸性粒细胞阳离子蛋白升高（≥20 μg/L）在激发试验阳性的婴儿中有22名（21%），激发试验阴性的婴儿中有7名（13%）。将上述四个试验以各自的临界值并行使用，能正确分类73%的婴儿，灵敏度为0.76，特异度为0.67。对牛奶激发试验的即刻反应与皮肤点刺试验阳性及血清牛奶特异性IgE升高相关，且倾向于与斑贴试验阳性相关。在这个前瞻性跟踪的、未经过筛选的6209名婴儿队列中，没有单一试验或四个试验并行使用能够令人满意地预测激发试验结果。对一项或多项试验的阳性反应需要通过激发试验来确认，而对所有四项试验的阴性反应并不能排除牛奶过敏的可能性。
