Allergy Unit - Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, CO 80045, USA.
Curr Opin Allergy Clin Immunol. 2020 Jun;20(3):233-241. doi: 10.1097/ACI.0000000000000640.
The aim of this review is to describe the role of precision medicine in the diagnosis, treatment, and monitoring of cow's milk allergy.
The development of 'omics' sciences in the field of food allergy has led to a better understanding of the allergenicity of cow's milk proteins and significant advances in the knowledge of the pathogenesis and mechanisms of cow's milk allergy. Omics-based technologies allow the practitioner to better differentiate cow's milk allergy subtypes and to predict cow's milk allergy (CMA) persistence over time. Precision medicine extends the role of the oral food challenge, to determine the individual's threshold doses, and to establish tolerance to baked milk products. Other than symptom relief, dietary strategies are currently being investigated for the potential to induce tolerance. Oral immunotherapy offers a treatment option for patients with severe and persistent IgE-mediated CMA. Individual baseline-immune profiles may be predictive of cow's milk oral immunotherapy safety and efficacy.Patient data derived from current technology, in combination with the patient's history, can be translated into treatments targeted at patient-tailored interventions.
The identification of novel biomarkers may improve diagnostic accuracy and also predict patient responsiveness to treatments. Integration of patient data will become increasingly important as omics technologies become more widely used in the clinical setting.
本综述旨在描述精准医学在牛奶过敏的诊断、治疗和监测中的作用。
“组学”科学在食物过敏领域的发展使我们对牛奶蛋白的变应原性有了更好的了解，并大大提高了对牛奶过敏发病机制和机制的认识。基于组学的技术使从业者能够更好地区分牛奶过敏亚型，并预测牛奶过敏（CMA）随时间的持续存在。精准医学扩展了口服食物挑战的作用，以确定个体的阈值剂量，并建立对烘焙奶制品的耐受性。除了缓解症状外，目前还在研究饮食策略是否有潜力诱导耐受。口服免疫疗法为严重和持续的 IgE 介导的 CMA 患者提供了一种治疗选择。个体基线免疫特征可能预测牛奶口服免疫疗法的安全性和疗效。从现有技术获得的患者数据，结合患者的病史，可以转化为针对患者的干预措施。
新型生物标志物的鉴定可能会提高诊断准确性，并且还可以预测患者对治疗的反应性。随着组学技术在临床环境中得到更广泛的应用，整合患者数据将变得越来越重要。
