Serum immunoglobulin E, IgA, and IgG antibodies to different cow's milk proteins in children with cow's milk allergy: Association with prognosis and clinical manifestations

Abstract

Diverse pathogenic mechanisms elicit different clinical manifestations in cow's milk allergy (CMA). Our aim was to determine the concentration of serum immunoglobulin levels to different cow's milk proteins in patients with CMA and to determine how these values were related to clinical symptoms and prognosis. Fifty children (mean age 10.9 months, range: 1-34 months) with previously confirmed CMA were enrolled in this study. All had various clinical manifestations of CMA, including gastrointestinal, skin, and respiratory symptoms. At the diagnosis of CMA the serum total and the milk-specific immunoglobulin (Ig)E values were measured by enzyme immunoassay and fluoroimmunoassay, respectively, while the relative levels of serum IgA and IgG antibodies against different cow's milk proteins were determined by a sensitive enzyme-linked immunosorbent assay (ELISA). The results were compared to those of 30 non-atopic age-matched control children. On average, after 9.2 months (range 2-31 months) on a milk-free diet, a repeated challenge was performed in 38 children. At the re-challenge, 12 patients had clinical symptoms while the remaining 26 children were symptom-free. The IgG antibody level to bovine serum albumin (BSA) was significantly lower in the patients than in the controls (median: 0.36 vs. 2.94, p< 0.01). There was a close correlation among all individual IgA and IgG antibodies to different cow's milk proteins. The anti-alpha-casein IgG level (of 2.10) in children with a positive reaction at the re-challenge was significantly higher than in those with a negative reaction (0.89) (p < 0.05). The total IgE serum concentration was also significantly higher in those who had symptoms at the re-challenge compared to those who did not have any reaction at this time (22.9 vs. 6.8 kU/l, geometric mean, p < 0.02). There was no association between the clinical manifestations and the IgG and IgA antibody levels to the cow's milk proteins studied, except for the anti-BSA IgA level, which was higher in patients with gastrointestinal symptoms. The serum total IgE and anti-alpha-casein IgG levels could have prognostic values; their increase at the beginning of the disease may indicate the development of tolerance to cow's milk only at a later age and after a longer duration of CMA. However, as there is considerable overlap among the values observed in different groups of patients, there is a limitation of these tests for predicting the prognosis.

Efficacy of Oral Antigen Specific Immunotherapy on Desensitization of Some Autoimmune Diseases Associated with Milk Allergy

“…This was showed from the significant decrease in the levels of specific IgE and total IgE as compared to their pretreatment levels, in spite of being, still higher than control values which might be considered the first signs of an immunologic effect of the therapy and indicated a marked improvement in allergic severity as supported by [32,33]. Also it means improvement in clinical manifestation of allergic disorder [25,34,35]. The mean values of RF titers after therapy were significantly reduced indicating improvement in the severity of the disease as a result of the immunotherapy ( Table 2).…”

Az allergia laboratóriumi diagnosztikájának rövid hazai története, a jelen lehetőségei és a jövő perspektívája

“…Nem tényleges és nem erős allergiamarkerek a valódi, markáns "allergénspecifi kus IgE" hatásához képest [12].…”

“…Kérésük és kivitelezésük nélkülözhető. Esetleges pozitivitásuk nem valódi allergiát mutat, de jelezhet bélgyulladást, rossz emésztést, fokozott bélper-meabilitást, "irritábilis bél szindrómát" [12,15].…”

Évaluation d'une nouvelle technique de dosage des immunoglobulines spécifiques E des protéines du lait de vache

“…Des tests spé-cifiques avec surtout la recherche des IgE antiprotéines du lait de vache (PLV) qui vont être dosées dans cette étude par deux types de protocoles : l'ancien qui détecte les IgE spécifiques [2,8] des PLV à partir de 0,35 KUI/l et le nouveau à partir de 0,1 KUI/l.…”