Tomicić Sara, Norrman Gunilla, Fälth-Magnusson Karin, Jenmalm Maria C, Devenney Irene, Böttcher Malin Fagerås
Division of Pediatrics, Department of Clinical and Experimental Medicine, and Unit of Clinical Experimental Research, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Pediatr Allergy Immunol. 2009 Feb;20(1):35-41. doi: 10.1111/j.1399-3038.2008.00738.x. Epub 2008 Mar 12.
Children with eczema and sensitization to foods are recommended skin care and, if food allergy is proven by challenge, an elimination diet. For most children the diet period is transient, but the process behind tolerance development and the influence of decreased allergen exposure is not fully known. The aim of the study was to investigate the effect of elimination diet on serum and salivary antibodies and to identify immunological parameters related to the ability to tolerate foods. Eighty-nine children, below 2 yr of age, with eczema and suspected food allergy were included. Recommended treatment was skin care to all children, and 60 children had a period of elimination diet. At 4(1/2) yr of age, the children were divided into two groups, based on if they had been able to introduce the eliminated foods, or not. Serum and salivary antibodies were analyzed with enzyme-linked immunosorbent assay and UniCAP before and after a 6-wk treatment period and at 4(1/2) yr of age. Children sensitized to egg and/or milk that could eat and drink the offending foods at 4(1/2) yr of age, had higher levels of Immunoglobulin G(4) antibodies to ovalbumin and beta-lactoglobulin and also higher IgG(4)/Immunoglobulin E ratios on inclusion in the study, than those who had to eliminate egg and/or milk from their diet, beyond 4(1/2) yr of age. The highest IgG(4)/IgE ratios were found in children with circulating IgE antibodies to egg and/or milk but negative skin prick test on inclusion. The 6-wk treatment period did not significantly affect the levels of serum and salivary antibodies. In conclusion, eczematous, food sensitized infants with high levels of IgG(4) and high ratios of IgG(4)/IgE antibodies to food allergens are more likely to consume these foods at 4(1/2) yr than infants with low levels and ratios.
对于患有湿疹且对食物过敏的儿童,建议进行皮肤护理;如果通过激发试验证实存在食物过敏,则需采用排除饮食法。对大多数儿童而言,饮食限制期是短暂的,但耐受形成背后的机制以及减少过敏原暴露的影响尚不完全清楚。本研究的目的是调查排除饮食对血清和唾液抗体的影响,并确定与食物耐受能力相关的免疫参数。研究纳入了89名2岁以下患有湿疹且疑似食物过敏的儿童。所有儿童均接受推荐的皮肤护理,其中60名儿童进行了一段时间的排除饮食。在4.5岁时,根据儿童是否能够重新引入已排除的食物,将他们分为两组。在为期6周的治疗期前后以及4.5岁时,采用酶联免疫吸附测定法和免疫化学发光法分析血清和唾液抗体。在研究纳入时,对鸡蛋和/或牛奶过敏且在4.5岁时能够食用这些致敏食物的儿童,其针对卵清蛋白和β-乳球蛋白的免疫球蛋白G4抗体水平较高,IgG4/免疫球蛋白E比值也较高,而那些在4.5岁后仍需从饮食中排除鸡蛋和/或牛奶的儿童则较低。在研究纳入时,循环中存在针对鸡蛋和/或牛奶的IgE抗体但皮肤点刺试验阴性的儿童,其IgG4/IgE比值最高。为期6周的治疗期对血清和唾液抗体水平没有显著影响。总之,与IgG4水平低和IgG4/IgE抗体比值低的婴儿相比,患有湿疹、对食物过敏且IgG4水平高、IgG4/IgE抗体与食物过敏原比值高的婴儿在4.5岁时更有可能食用这些食物。