Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Allergy Clin Immunol. 2013 Jan;131(1):180-6.e1-3. doi: 10.1016/j.jaci.2012.06.003. Epub 2012 Jul 20.
In our previous study about 75% of children with cow's milk allergy tolerated baked milk products, which improved their prognosis and quality of life.
We sought to identify biomarkers of varying degrees of clinical tolerance among a cohort of children with cow's milk allergy.
One hundred thirty-two subjects were initially classified as baked milk-reactive, baked milk-tolerant, or having "outgrown milk allergy" based on the results of oral food challenges. The baked milk-tolerant group was then divided into 3 groups based on the amount and degree of heat-denatured milk protein that they could tolerate. Serum was analyzed for allergen-specific IgE and IgG(4) levels, basophil reactivity was assessed in whole blood stimulated with serial 10-fold dilutions of milk protein, and skin prick tests (SPTs) were performed to commercial milk extract. Activated basophils were defined by using flow cytometry as CD63(bright)CD203c(+)CD123(+)HLA-DR(dim/-)CD41a(-)lineage(-). Data were analyzed by using the Jonckheere-Terpstra test.
Significant differences across the 5 clinical groups were seen for median casein- and milk-specific IgE levels, casein-specific IgG(4) levels, and casein IgE/IgG(4) ratios; milk-specific to nonspecific basophil activation ratio, median basophil reactivity, and spontaneous basophil activation (CD203c expression after stimulation with RPMI); and milk SPT wheal diameters. Casein- and milk-specific IgE level, milk-specific basophil reactivity, and milk SPT wheal diameter are all significantly greater among patients with milk allergy who react to baked milk than among those who tolerate it.
The majority of patients with milk allergy are able to tolerate some forms of baked milk in their diets. Different phenotypes of children with cow's milk allergy can be distinguished by casein- and milk-specific IgE levels, milk-specific basophil reactivity, and milk SPT mean wheal diameters. Spontaneous basophil activation is greater among patients with more severe clinical milk reactivity.
在我们之前的研究中，约 75%的牛奶过敏儿童能够耐受烘焙奶制品，这改善了他们的预后和生活质量。
我们试图在一组牛奶过敏儿童中确定不同程度临床耐受的生物标志物。
根据口服食物挑战的结果，最初将 132 名受试者分为烘焙奶反应、烘焙奶耐受或“已摆脱牛奶过敏”。然后，根据他们能够耐受的热变性牛奶蛋白的量和程度，将烘焙奶耐受组进一步分为 3 组。分析血清中过敏原特异性 IgE 和 IgG(4)水平，使用 10 倍稀释系列牛奶蛋白刺激全血评估嗜碱性粒细胞反应，并对商业牛奶提取物进行皮肤点刺试验 (SPT)。通过使用流式细胞术将激活的嗜碱性粒细胞定义为 CD63(bright)CD203c(+)CD123(+)HLA-DR(dim/-)CD41a(-)谱系(-)。使用 Jonckheere-Terpstra 检验分析数据。
在 5 个临床组之间，观察到酪蛋白和牛奶特异性 IgE 水平、酪蛋白特异性 IgG(4)水平和酪蛋白 IgE/IgG(4)比值的中位数、牛奶特异性和非特异性嗜碱性粒细胞活化比、中位数嗜碱性粒细胞反应和自发嗜碱性粒细胞活化 (在 RPMI 刺激后 CD203c 表达)以及牛奶 SPT 风团直径存在显著差异。与耐受烘焙奶的牛奶过敏患者相比，对烘焙奶有反应的牛奶过敏患者的酪蛋白和牛奶特异性 IgE 水平、牛奶特异性嗜碱性粒细胞反应和牛奶 SPT 风团直径均显著更高。
大多数牛奶过敏患者能够在饮食中耐受某些形式的烘焙奶。通过酪蛋白和牛奶特异性 IgE 水平、牛奶特异性嗜碱性粒细胞反应和牛奶 SPT 平均风团直径，可以区分不同表型的牛奶过敏儿童。在具有更严重临床牛奶反应的患者中，自发嗜碱性粒细胞活化更高。
