Payot F, Berthiller J, Kassai B, Brunet A-S, Villard-Truc F, Lachaux A
Hospices Civils de Lyon, Lyon 1 University, Allergology Unit, Department of Pediatrics, HFME Children's Hospital of Lyon, CHU de Lyon, 59 bvd Pinel, 69677 Bron, France.
Hôpital Louis Pradel, EPICIME-INSERM CIC201, 28, Avenue du Doyen Lépine, 69677 cedex, Bron, France; Université Lyon 1, Equipe d'Accueil 4129, France; CHU Lyon, Service de Pharmacologie Clinique, 8 rue Guillaume Paradin, BP8071, 69376 cedex 08, Lyon, France.
Allergol Immunopathol (Madr). 2014 Sep-Oct;42(5):395-401. doi: 10.1016/j.aller.2013.03.007. Epub 2013 Jun 20.
Cow's milk protein allergy (CMPA) represents one of the leading causes of food allergy in infants and young children. The immune reaction may be IgE mediated, non-IgE mediated, or mixed. IgE-mediated cow's milk protein allergy is revealed by immediate and acute symptoms which can be severe. The aim of this study is to report a one centre experience in the real life of testing children with IgE-mediated CMPA and try to identify predictive factor for follow-up challenges.
Retrospective and monocentric study between September 1997 and February 2008. 178 infants diagnosed with IgE-mediated CMPA during breastfeeding weaning were included. Initial factors such as age, sex, skin prick tests (SPTs), specific IgE (sIgE), atopic dermatitis and types of reaction were noted. Between 12 and 24 months all infants have undergone at least one evaluation including SPT.
At the food challenge, 138 (75.8%) infants were found tolerant. Results of the skin prick test (SPT) were statistically different according to the food challenge result (2.2mm vs. 5.1mm, p<0.0001). It was the same result for sIgE for CM 2.0ku/l vs. 11.5ku/l - p<0.0001 and for casein 1.0ku/l vs. 16.0ku/l - p=0.0014.
This study confirms the practical interest of both SPT and sIgE in the evaluation of tolerance induction in IgE-mediated CMPA, but with no corresponding results. Sensitivity, specificity and probability curves of success for cow's milk challenge can be determined and have clinical utility.
牛奶蛋白过敏（CMPA）是婴幼儿食物过敏的主要原因之一。免疫反应可能由IgE介导、非IgE介导或混合介导。IgE介导的牛奶蛋白过敏表现为即刻和急性症状，可能较为严重。本研究旨在报告一个中心在现实生活中对IgE介导的CMPA患儿进行检测的经验，并试图确定随访激发试验的预测因素。
1997年9月至2008年2月的回顾性单中心研究。纳入178例在母乳喂养断奶期间被诊断为IgE介导的CMPA的婴儿。记录初始因素，如年龄、性别、皮肤点刺试验（SPT）、特异性IgE（sIgE）、特应性皮炎和反应类型。在12至24个月期间，所有婴儿至少接受了一次包括SPT在内的评估。
在食物激发试验中，138例（75.8%）婴儿被发现耐受。根据食物激发试验结果，皮肤点刺试验（SPT）结果在统计学上存在差异（2.2mm对5.1mm，p<0.0001）。CM的sIgE结果（2.0ku/l对11.5ku/l，p<0.0001）以及酪蛋白的sIgE结果（1.0ku/l对16.0ku/l，p=0.0014）也是如此。
本研究证实了SPT和sIgE在评估IgE介导的CMPA耐受诱导中的实际意义，但结果并不对应。可以确定牛奶激发试验的敏感性、特异性和成功概率曲线，且具有临床实用性。
