Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Immun Inflamm Dis. 2024 May;12(5):e1265. doi: 10.1002/iid3.1265.
The basophil activation test is an emerging clinical tool in the diagnosis of cow's milk allergy (CMA). The aim was to assess the association between the basophil allergen threshold sensitivity to the major milk protein casein (casein-specific CD-sens), the levels of milk- and casein-specific Immunoglobulin E antibodies (IgE-ab), and the severity of allergic reactions at milk challenges.
We enrolled 34 patients aged 5-15 (median 9) years who underwent a double-blind placebo-controlled milk-challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson's severity score. Venous blood was drawn before the DBPCMC. Milk- and casein-specific IgE-ab were analyzed. Following in vitro stimulation of basophils with casein, casein-specific CD-sens, was determined.
Thirty-three patients completed the DBPCMC. There were strong correlations between casein-specific CD-sens and IgE-ab to milk (r = 0.682, p < .001), and between casein-specific CD-sens and IgE-ab to casein (r = 0.823, p < .001). There was a correlation between the severity of the allergic reaction and casein-specific CD-sens level (r = 0.395, p = .041) and an inverse correlation between casein-specific CD-sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (r = -0.418, p = .027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein-specific CD-sens, 23% had negative casein-specific CD-sens, and 10% were declared non-responders.
Two thirds of those reacting at the DBPMC had positive casein-specific CD-sens, but reactions also occurred despite negative casein-specific CD-sens. The association between casein-specific CD-sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate.
嗜碱性粒细胞激活试验是一种新兴的临床工具，用于诊断牛奶过敏（CMA）。本研究旨在评估主要牛奶蛋白酪蛋白的嗜碱性粒细胞变应原阈值敏感性（酪蛋白特异性 CD-sens）、牛奶和酪蛋白特异性免疫球蛋白 E 抗体（IgE-ab）水平与牛奶激发试验中过敏反应严重程度之间的关系。
我们纳入了 34 名 5-15 岁（中位年龄 9 岁）的患者，这些患者在参加口服免疫治疗 CMA 研究之前均接受了双盲安慰剂对照牛奶激发试验（DBPCMC）作为筛查。采用 Sampson 严重程度评分系统对 DBPCMC 中的过敏反应严重程度进行分级。在 DBPCMC 之前采集静脉血。分析牛奶和酪蛋白特异性 IgE-ab。用酪蛋白体外刺激嗜碱性粒细胞后，测定酪蛋白特异性 CD-sens。
33 名患者完成了 DBPCMC。酪蛋白特异性 CD-sens 与牛奶特异性 IgE-ab 之间（r=0.682，p<0.001）和酪蛋白特异性 CD-sens 与酪蛋白特异性 IgE-ab 之间（r=0.823，p<0.001）存在强相关性。过敏反应严重程度与酪蛋白特异性 CD-sens 水平之间存在相关性（r=0.395，p=0.041），酪蛋白特异性 CD-sens 水平与患者在 DBPCMC 中对牛奶蛋白的累积剂量之间呈负相关（r=-0.418，p=0.027）。在 30 名在 DBPCMC 中发生过敏反应的患者中，67%的患者具有阳性酪蛋白特异性 CD-sens，23%的患者具有阴性酪蛋白特异性 CD-sens，10%的患者被宣布为无反应者。
在 DBPCMC 中发生反应的患者中，有三分之二的患者具有阳性酪蛋白特异性 CD-sens，但即使在酪蛋白特异性 CD-sens 阴性的情况下，也会发生反应。酪蛋白特异性 CD-sens 与过敏反应严重程度和牛奶蛋白累积剂量之间的相关性中等。
