Division of Allergy/Immunology/Rheumatology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Asian Pac J Allergy Immunol. 2014 Jun;32(2):171-7. doi: 10.12932/AP0319.32.2.2013.
To study changes in immunological responses in patients with CMPA during symptomatic and asymptomatic episodes of cow's milk protein tolerance status.
27 CMPA patients were enrolled and underwent diagnostic evaluation, including CM challenge test, skin prick test and specific IgE to CM. Blood samples were collected in two periods from those who became tolerant (n = 13) and those with persistent CMA (n = 14), in order to measure in vitro PBMC responses to cow's milk protein (IL-10, IFN-γ, IL-5), IgG4 to β-lactoglobulin, casein, BLG-IgG4/IgE ratio and the CAS-IgG4/IgE ratio.
Seventy percent of CMPA patients in our study were male with a mean age at diagnosis of 8 months and mean age of onset of 3 months. The reaction time to CM ranged from within 7 minutes to within 14 days. Positive IgE-sensitization was defined as either a specific IgE to CM of more than 0.35 kUA/L (N=11) or SPTs positive for CM and/or fresh cow's milk (N=20). Forty-eight percent of the patients (n = 13) could tolerate CM by 13.38 months (8-19 months). Mean specific-IgE levels to CM were 4.1 kUA/L (range 0.35-14.3 kUA/L). Determination of the cytokine (IL-10, IFN-γ, IL-5) response to BLG revealed significantly higher IL-10 levels during the tolerance phase (212.93 vs 142.46 pg/ml, P = .011). There was a significant increase in BLG-IgG4 and the BLG-IgG4/IgE ratio in the tolerance phase when compared to the symptomatic phase.
IL-10, BLG-IgG4 and the BLG-IgG4/IgE ratio were higher in CMPA patients during the tolerance phase compared to the symptomatic phase.
研究变应性乳蛋白耐受状态下乳蛋白过敏（CMPA）患者在有症状和无症状期免疫反应的变化。
纳入 27 例 CMPA 患者进行诊断评估，包括 CM 激发试验、皮肤点刺试验和 CM 特异性 IgE。对 13 例转为耐受的患者（n = 13）和 14 例持续 CMA 患者（n = 14）的血液样本分别在两个时期采集，以测量体外 PBMC 对乳蛋白（IL-10、IFN-γ、IL-5）的反应、β-乳球蛋白、酪蛋白、BLG-IgG4/IgE 比值和 CAS-IgG4/IgE 比值的 IgG4。
我们研究中的 70%的 CMPA 患者为男性，诊断时的平均年龄为 8 个月，发病时的平均年龄为 3 个月。CM 的反应时间从 7 分钟到 14 天不等。定义阳性 IgE 致敏为 CM 特异性 IgE 大于 0.35 kUA/L（n = 11）或 CM 和/或新鲜牛奶 SPT 阳性（n = 20）。48%的患者（n = 13）在 13.38 个月（8-19 个月）时可耐受 CM。CM 的平均特异性 IgE 水平为 4.1 kUA/L（范围 0.35-14.3 kUA/L）。测定 BLG 对细胞因子（IL-10、IFN-γ、IL-5）的反应显示，在耐受期 IL-10 水平显著升高（212.93 与 142.46 pg/ml，P =.011）。与有症状期相比，耐受期 BLG-IgG4 和 BLG-IgG4/IgE 比值显著增加。
与有症状期相比，CMPA 患者在耐受期的 IL-10、BLG-IgG4 和 BLG-IgG4/IgE 比值更高。
