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Specific antibodies in oral immunotherapy for cow's milk allergy: kinetics and prediction of clinical outcome.

AbstractBACKGROUND:
METHODS for predicting the clinical outcome of specific oral immunotherapy (OIT) would improve the safety of the therapy.
METHODS:
We investigated 40 children aged 6-17 years with IgE-mediated cow's milk allergy (CMA) who either successfully completed OIT (n = 32) or discontinued the therapy due to adverse reactions (n = 8). From sera drawn before and after OIT, we analyzed specific IgA, IgG, IgG1 and IgG4 to cow's milk (CM), casein, β-lactoglobulin and ovalbumin (with enzyme-linked immunosorbent assay) and IgE to CM and hen's egg white [with enzymatic fluoroimmunoassay (Phadia ThermoFisher Scientific CAP system)]. As a reference, we also analyzed serum samples from 8- to 9-year-old children who either had no history of CMA (n = 76) or who had spontaneously recovered from IgE-mediated CMA (n = 56).
RESULTS:
Levels of specific IgA, IgG, IgG1 and IgG4 to CM and casein, and CM-specific IgE prior to OIT were higher in children who discontinued the therapy than in those who achieved desensitization (p < 0.05). Adverse reactions in the entire population were associated with low IgG and IgG4, but high IgG1 levels to ovalbumin (p < 0.05). Specific IgA, IgG, IgG1 and IgG4 to CM proteins significantly increased and IgE to CM decreased during OIT in children who achieved desensitization (p < 0.01). In those who discontinued OIT, only IgG, IgG1 and IgG4 to CM increased significantly (p < 0.03) and CM IgE remained unchanged.
CONCLUSIONS:
High specific IgE, IgA and IgG-class antibodies to CM proteins appear to predict failure to achieve desensitization in CM OIT. Specific IgA and IgG-class antibodies to CM increase and CM IgE decreases during desensitization.
AuthorsEmma M Savilahti, Mikael Kuitunen, Erkki Savilahti, Mika J Mäkelä
JournalInternational archives of allergy and immunology (Int Arch Allergy Immunol) Vol. 164 Issue 1 Pg. 32-9 ( 2014) ISSN: 1423-0097 [Electronic] Switzerland
PMID24853260 (Publication Type: Journal Article)
Copyright© 2014 S. Karger AG, Basel.
Chemical References
  • Caseins
  • Immunoglobulin A
  • Immunoglobulin G
  • Lactoglobulins
  • Ovalbumin
Topics
  • Administration, Oral
  • Adolescent
  • Animals
  • Caseins (immunology)
  • Child
  • Desensitization, Immunologic (methods)
  • Female
  • Humans
  • Immunoassay
  • Immunoglobulin A (blood, immunology)
  • Immunoglobulin G (blood, immunology)
  • Kinetics
  • Lactoglobulins (immunology)
  • Male
  • Milk (immunology)
  • Milk Hypersensitivity (blood, immunology, prevention & control)
  • Ovalbumin (immunology)
  • Treatment Outcome

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