Sakihara Tetsuhiro, Otsuji Kenta, Arakaki Yohei, Hamada Kazuya, Sugiura Shiro, Ito Komei
Department of Pediatrics, Heartlife Hospital, Okinawa, Japan.
Department of Pediatrics, Okinawa Kyodo Hospital, Okinawa, Japan.
J Allergy Clin Immunol Glob. 2024 Apr 10;3(3):100257. doi: 10.1016/j.jacig.2024.100257. eCollection 2024 Aug.
Early supplementation and subsequent discontinuation of cow's milk formula (CMF) may increase the risk of cow's milk allergy in breast-fed infants, but little is known about the relationship between continuous CMF ingestion and cow's milk protein-specific immunoglobulin production.
This study aimed to clarify the aforesaid relationship in cow's milk-sensitized infants.
Using data from a randomized controlled trial of a Japanese birth cohort, we performed a subgroup analysis of participants who had ingested CMF in the first 3 days of life and exhibited a positive skin prick test response to cow's milk at age 6 months. We compared the differences in median titers of cow's milk-specific IgE, casein-specific IgE, and casein-specific IgG4 levels between participants who continued daily or intermittent CMF ingestion up to age 6 months (the "continuous group") and participants who discontinued CMF ingestion before age 6 months (the "discontinued group").
From among 462 trial participants, 49 (10.6%) were included in this study (21 in the continuous group and 29 in the discontinued group). The median titer of cow's milk-specific IgE was 0.17 kUA/L (interquartile range [IQR] = <0.10 to 0.57) in the continuous group and 0.66 kUA/L (IQR = 0.49-1.18) in the discontinued group ( = .0008). The median titer of casein-specific IgE was <0.10 kUA/L (IQR = <0.10 to 0.15) in the continuous group and <0.10 kUA/L (IQR = <0.10 to 0.37) in the discontinued group ( = .51). The median titer of casein-specific IgG4 was 2.58 mg/L (IQR = 0.77-6.73) in the continuous group and 0.09 mg/L (IQR = 0.07-0.13) in the discontinued group ( < .0001).
Continuous CMF ingestion may promote casein-specific IgG4 production in cow's milk-sensitized infants.
早期补充并随后停用牛奶配方奶粉（CMF）可能会增加母乳喂养婴儿患牛奶过敏的风险，但关于持续摄入CMF与牛奶蛋白特异性免疫球蛋白产生之间的关系，人们知之甚少。
本研究旨在阐明牛奶致敏婴儿中上述关系。
利用一项日本出生队列随机对照试验的数据，我们对出生后前3天摄入CMF且6个月龄时牛奶皮肤点刺试验结果呈阳性的参与者进行了亚组分析。我们比较了持续每日或间歇性摄入CMF至6个月龄的参与者（“持续摄入组”）与在6个月龄前停止摄入CMF的参与者（“停止摄入组”）之间牛奶特异性IgE、酪蛋白特异性IgE和酪蛋白特异性IgG4水平的中位数滴度差异。
在462名试验参与者中，49名（10.6%）被纳入本研究（持续摄入组21名，停止摄入组29名）。持续摄入组牛奶特异性IgE的中位数滴度为0.17 kUA/L（四分位间距[IQR]=<0.10至0.57），停止摄入组为0.66 kUA/L（IQR=0.49 - 1.18）（P = 0.0008）。持续摄入组酪蛋白特异性IgE的中位数滴度<0.10 kUA/L（IQR=<0.10至0.15），停止摄入组为<0.10 kUA/L（IQR=<0.10至0.37）（P = 0.51）。持续摄入组酪蛋白特异性IgG4的中位数滴度为2.58 mg/L（IQR=0.77 - 6.73），停止摄入组为0.09 mg/L（IQR=0.07 - 0.13）（P<0.0001）。
持续摄入CMF可能会促进牛奶致敏婴儿中酪蛋白特异性IgG4的产生。
