Specific IgG4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:142

Article

Schuyler, Alexander J.¹  Wilson, Jeffrey M.¹  Tripathi, Anubha¹  Commins, Scott P.³  Ogbogu, Princess U.⁴  Kruzsewski, Patrice G.⁵  Barnes, Barrett H.²  McGowan, Emily C.¹  Workman, Lisa J.¹  Lidholm, Jonas⁶  Rifas-Shiman, Sheryl L.^7,8,9  Oken, Emily^7,8,9  Gold, Diane R.¹⁰  Platts-Mills, Thomas A. E.¹  Erwin, Elizabeth A.¹¹ 

[1] Univ Virginia, Div Allergy & Clin Immunol, Charlottesville, VA USA

[2] Univ Virginia, Div Pediat Gastroenterol, Charlottesville, VA USA

[3] Univ N Carolina, Div Rheumatol Allergy & Immunol, Chapel Hill, NC 27515 USA

[4] Ohio State Univ, Dept Otolaryngol, Wexner Med Ctr, Allergy & Immunol, Columbus, OH 43210 USA

[5] Emory Univ, Div Pediat Gastroenterol Hepatol & Nutr, Atlanta, GA 30322 USA

[6] Thermo Fisher Sci, Uppsala, Sweden

[7] Harvard Med Sch, Dept Populat Med, Boston, MA USA

[8] Harvard Med Sch, Harvard Pilgrim Hlth Care Inst, Boston, MA USA

[9] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Channing Div Network Med, Boston, MA USA

[10] Harvard TH Chan Sch Publ Hlth, Dept Environm Hlth, Boston, MA USA

[11] Nationwide Childrens Hosp, Ctr Innovat Pediat Practice, 700 Childrens Dr, Columbus, OH 43205 USA

关键词: Eosinophilic esophagitis;    children;    IgG(4) assays;    cow's milk proteins;    molecular allergens;   

DOI  :  10.1016/j.jaci.2018.02.049

来源: Elsevier

【 摘 要 】

Background: Allergen-specific IgG(4) (sIgG(4)) antibodies are often associated with tolerance, but sIgG(4) antibodies to causally relevant foods have been reported recently in adults with eosinophilic esophagitis (EoE). Prevalence and levels of food sIgG(4) are not well established in the general pediatric population. Objective: We sought to investigate serum food sIgG(4) with component diagnostics in children with EoE and children from an unselected birth cohort and to explore the effects of sex, age, and milk consumption on sIgG(4) levels. Methods: Sera from 71 pediatric patients with EoE and 210 early adolescent children from an unselected birth cohort (Project Viva) were assayed for sIgG(4) and specific IgE (sIgE) to major cow's milk (CM) proteins (alpha-lactalbumin, beta-lactoglobulin, and caseins) and to wheat, soy, egg, and peanut proteins. Results: In the EoE cohort high-titer sIgG(4) (>= 10 mu g/mL) to CM proteins was more common than in control sera and achieved odds ratios for EoE ranging from 5.5 to 8.4. sIgE levels to CM proteins were mostly 4 IU/mL or less in patients with EoE, such that sIgG(4)/sIgE ratios were often 10,000 or greater. When adjusted for age and milk consumption, high-titer sIgG(4) to CM proteins was strongly associated with EoE, with an odds ratio of greater than 20 to all 3 CM proteins in boys. Conclusions: sIgG(4) to CM proteins are common and high titer in children with EoE. Although it is not clear that this response is pathogenic, sIgG(4) levels imply that these antibodies are an important feature of the local immune response that gives rise to EoE.

【 授权许可】

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