Duration of clinical reactivity in cow's milk allergy is associated with levels of specific immunoglobulin G4 and immunoglobulin A antibodies to beta-lactoglobulin.

Abstract

BACKGROUND:

The development of tolerance in IgE-mediated allergies has been associated with lower cow's milk (CM)-specific IgE levels, increasing levels of specific IgG4 and, more contestably, IgA.

OBJECTIVE:

We investigated whether specific antibody responses to CM proteins differ over time between patients who recovered from cow's milk allergy (CMA) by the age of 3 years and those who developed tolerance only after the age of 8 years.

METHODS:

The study population comprised of 83 patients with IgE-mediated CMA. They belonged to a cohort of 6209 healthy, full-term infants followed prospectively for the emergence of CMA. Serum samples were available at diagnosis (median age 7 months), 1 year later (median 19 months) and at follow-up (median 8.5 years). Age-matched control subjects with no history of CMA (n=76) participated in the follow-up. Serum levels of IgE antibodies to CM were measured using UniCAP. Levels of IgA, IgG1 and IgG4 antibodies to beta-lactoglobulin and alpha-casein were measured using ELISA.

RESULTS:

Patients with persistent CMA at the age of 8 years (n=18 at diagnosis, n=16 at later time-points) had higher CM-specific IgE levels at all three time-points (P<0.001) compared with patients who became tolerant by 3 years (n=55 at diagnosis, n=54 a year later, n=40 at follow-up). They had lower serum IgA levels to beta-lactoglobulin at diagnosis (P=0.01), and lower IgG4 levels to beta-lactoglobulin (P=0.04) and alpha-casein (P=0.05) at follow-up.

CONCLUSION:

High CM-specific IgE levels predict the persistence of CMA. Development of tolerance is associated with elevated levels of beta-lactoglobulin-specific serum IgA at the time of diagnosis, and later increasing specific IgG4 levels to beta-lactoglobulin and alpha-casein.

• Authors: E M Savilahti, K M Saarinen, E Savilahti
• Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (Clin Exp Allergy) Vol. 40 Issue 2 Pg. 251-6 (Feb 2010) ISSN: 1365-2222 [Electronic] England
• PMID: 19958365 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulin A
• Immunoglobulin G
• Lactoglobulins
• Immunoglobulin E

Topics

• Aging (immunology)
• Child
• Child, Preschool
• Humans
• Immune Tolerance (immunology)
• Immunoglobulin A (blood, immunology)
• Immunoglobulin E (blood, immunology)
• Immunoglobulin G (blood, immunology)
• Immunotherapy
• Lactoglobulins (immunology)
• Milk Hypersensitivity (blood, diagnosis, immunology, therapy)
• Prospective Studies
• Time Factors