Gunaydin Nursen Cigerci, Severcan Ezgi Ulusoy, Akarcan Sanem Eren, Bal Cem Murat, Gulen Figen, Tanac Remziye, Demir Esen
Department of Pediatrics, Division of Pediatric Allergy and Immunology, Namık Kemal University, Faculty of Medicine, Tekirdag, Turkey.
Department of Pediatric Immunology and Allergy, University of Health Sciences Turkey, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara,Turkey.
Sisli Etfal Hastan Tip Bul. 2021 Sep 24;55(3):391-397. doi: 10.14744/SEMB.2020.90688. eCollection 2021.
Cow's milk (CM) contains some proteins capable of causing an allergic reaction in a sensitized individual and one of the most common causes of food allergy in childhood. Most of the patients will develop tolerance by the age of 3. In this study, we aimed to evaluate sensitivity to CM allergen components as well as goat's milk (GM) and sheep's milk cross reactions in cow's milk allergic (CMA) patients and to figure out the risk factors for tolerance non-development.
This is a retrospective cross-sectional study including 66 patients for IgE-mediated CMA with mean age of 38 months. We evaluated the patients in two groups: Group 1 (=50): Patients who have no tolerance in oral food challenge test; Group 2 (= 16): Patients who were found tolerant to CM after elimination diet. Cow's milk-spesific IgE(sIgE), α-lactalbumin(ALA)-sIgE, β-Lactoglobulin(BLG)-sIgE, casein-sIgE, goat's milk-sIgE, sheep's milk-sIgE, skin prick tests(SPTs) with CM and GM, eosinophils in peripheral blood were all compared between two groups.
In the whole group, goat's milk-sIgE and sheep's milk-sIgE were positive in 84.8% and ALA-sIgE, BLG-sIgE, casein-sIgE were positive in 69.7%, 62.7%, 77.3% of the patients, respectively. Two groups were similar in terms of age at onset and diagnosis, gender, median elimination period, total IgE levels, cow's milk-sIgE and eosinophilia (p>0.05). Mean wheal diameters of CM and GM in SPT (p<0.001), goat's milk-sIgE (p=0.03), sheep's milk-sIgE (p=0.01) were significantly higher in Group 1. Cow's milk-sIgE showed a positive correlation with total IgE (p=0.001), eosinophilia percentage (p=0.04), CM wheal diameter in SPT (p=0.001), casein-sIgE (p<0.001), goat's milk-sIgE (p<0.001), sheep's milk-sIgE (p<0.001) in Group 1. Patients with respiratory symptoms and history of anaphylaxis had higher cow's milk-SPT, cow's milk-sIgE, casein-sIgE, goat's milk-sIgE, sheep's milk-sIgE levels(p<0.05). Gastrointestinal and skin symptoms showed no relation with laboratory findings. Any patient with a history of anaphylaxis did not develop tolerance.
As with cow's milk-sIgE levels and high induration diameters in SPT; high casein-sIgE, sheep's milk-sIgE and goat's milk-sIgE levels are also risk factors for persistence of CMA. Anaphylaxis, as a first reaction, may also be a risk factor. High cow's milk-sIgE, casein-sIgE, sheep's milk-sIgE, goat's milk-sIgE levels are associated with respiratory symptoms.
牛奶（CM）含有一些能在致敏个体中引发过敏反应的蛋白质，是儿童食物过敏最常见的原因之一。大多数患者在3岁时会产生耐受性。在本研究中，我们旨在评估牛奶过敏（CMA）患者对CM过敏原成分的敏感性以及羊奶（GM）和绵羊奶的交叉反应，并找出耐受性未形成的危险因素。
这是一项回顾性横断面研究，纳入66例IgE介导的CMA患者，平均年龄38个月。我们将患者分为两组：第1组（=50）：口服食物激发试验无耐受性的患者；第2组（=16）：经消除饮食后对CM耐受的患者。比较两组之间的牛奶特异性IgE（sIgE）、α-乳白蛋白（ALA）-sIgE、β-乳球蛋白（BLG）-sIgE、酪蛋白-sIgE、羊奶-sIgE、绵羊奶-sIgE、CM和GM的皮肤点刺试验（SPT）以及外周血嗜酸性粒细胞。
在整个队列中，84.8%的患者羊奶-sIgE和绵羊奶-sIgE呈阳性，69.7%、62.7%、77.3%的患者ALA-sIgE、BLG-sIgE、酪蛋白-sIgE呈阳性。两组在发病和诊断年龄、性别、中位消除期、总IgE水平、牛奶-sIgE和嗜酸性粒细胞增多方面相似（p>0.05）。第1组SPT中CM和GM的平均风团直径（p<0.001）、羊奶-sIgE（p=0.03）、绵羊奶-sIgE（p=0.01）显著更高。第1组中牛奶-sIgE与总IgE（p=0.001）、嗜酸性粒细胞增多百分比（p=0.04）、SPT中CM风团直径（p=0.001）、酪蛋白-sIgE（p<0.001）、羊奶-sIgE（p<0.001）、绵羊奶-sIgE（p<0.001）呈正相关。有呼吸道症状和过敏反应史的患者牛奶-SPT、牛奶-sIgE、酪蛋白-sIgE、羊奶-sIgE、绵羊奶-sIgE水平更高（p<0.05）。胃肠道和皮肤症状与实验室检查结果无关。有过敏反应史的患者均未产生耐受性。
与牛奶-sIgE水平和SPT中高硬结直径一样；高酪蛋白-sIgE、绵羊奶-sIgE和羊奶-sIgE水平也是CMA持续存在的危险因素。过敏反应作为首发反应，也可能是一个危险因素。高牛奶-sIgE、酪蛋白-sIgE、绵羊奶-sIgE、羊奶-sIgE水平与呼吸道症状相关。
