Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Clinical Research Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Immunol. 2024 Feb 14;15:1281741. doi: 10.3389/fimmu.2024.1281741. eCollection 2024.
Allergic diseases in children are major public health concerns due to their widespread and rising prevalence. Food-specific immunoglobulin G4(FS-IgG4) has been detected in patients with allergic diseases, but its clinical significance is still debated. In the present study, 407 children with allergic diseases were recruited and categorized into three groups according to the different systems involved: the respiratory system group, the skin system group, and a multiple system group, with the collection of clinical symptoms and serum antibodies, including total immunoglobulin E (IgE), house dust mite (HDM) IgE, food-specific IgE (FS-IgE), and FS-IgG4. Part of these patients were followed up with the intervention of FS-IgG4-guided diet elimination with or without add-on probiotics supplement. The analysis at baseline revealed distinct serum levels of different antibodies. The positive rate of FS-IgG4 in all groups was more than 80%, and the proportion of total IgE and FS-IgG4 both positive in the multi-system group was the highest (p=0.039). Egg and milk were the foods with the highest positive rate of FS-IgG4 in all groups. After diet elimination for more than 3 months, serum FS-IgG4 in children significantly decreased (P<0.05) along with the improvement of clinical symptoms, regardless of the add-on of probiotics. However, the intervention did not impact the serum levels of total IgE, FS-IgE, and HDM IgE. There was no further decrease of serum FS-IgG4 level in children followed up for more than 1 year, which may be related to noncompliance with diet elimination. Multivariate regression analysis revealed that the decline of serum FS-IgG4 was an independent predictable factor for the improvement of clinical symptoms (adjusted OR:1.412,95%CI 1.017-1.96, p=0.039). The add-on of probiotics showed less efficiency in reducing the FS-IgG4 level in more patients with relief of clinical symptoms. Our results confirmed the correlation between FS-IgG4 and allergic diseases, and the decreased FS-IgG4 could be a useful predictor for the improvement of allergic symptoms. FS-IgG4-guided diet elimination is an efficient treatment for allergic diseases. Our study adds solid data to the clinical significance of FS-IgG4 in allergic diseases.
儿童过敏性疾病是一个主要的公共卫生问题，因为它们的发病率广泛且呈上升趋势。在过敏性疾病患者中已检测到食物特异性免疫球蛋白 G4（FS-IgG4），但其临床意义仍存在争议。本研究纳入了 407 例过敏性疾病患儿，根据受累系统的不同将其分为三组：呼吸系统组、皮肤系统组和多系统组，收集临床症状和血清抗体，包括总免疫球蛋白 E（IgE）、屋尘螨（HDM）IgE、食物特异性 IgE（FS-IgE）和 FS-IgG4。部分患者接受 FS-IgG4 指导的饮食消除治疗，加用或不加用益生菌补充剂。基线分析显示不同抗体的血清水平存在差异。所有组 FS-IgG4 的阳性率均超过 80%，多系统组总 IgE 和 FS-IgG4 均阳性的比例最高（p=0.039）。所有组 FS-IgG4 阳性率最高的食物是鸡蛋和牛奶。饮食消除 3 个月以上后，儿童血清 FS-IgG4 显著下降（P<0.05），同时临床症状改善，加用益生菌与否均如此。然而，干预并未影响总 IgE、FS-IgE 和 HDM IgE 的血清水平。1 年以上随访的儿童血清 FS-IgG4 水平无进一步下降，可能与饮食消除不依从有关。多变量回归分析显示，血清 FS-IgG4 下降是临床症状改善的独立预测因素（调整 OR：1.412，95%CI 1.017-1.96，p=0.039）。在更多缓解临床症状的患者中，加用益生菌对降低 FS-IgG4 水平的效果较小。我们的结果证实了 FS-IgG4 与过敏性疾病之间的相关性，FS-IgG4 的降低可能是过敏性症状改善的有用预测指标。FS-IgG4 指导的饮食消除是治疗过敏性疾病的有效方法。我们的研究为 FS-IgG4 在过敏性疾病中的临床意义提供了可靠的数据支持。
