Local immune response in patients with cow milk allergy: follow-up of patients retaining allergy or becoming tolerant.
To assist in identifying factors that determine the clinical outcome of cow milk allergy, we subjected to rechallenge 37 patients with a history of cow milk allergy, mean (+/- SD) age 27.6 +/- 7.1 months, after a follow-up of 13.5 +/- 5.1 months with a milk-free diet. A solid-phase enzyme-linked immunoassay was used to assess the total number of immunoglobulin-secreting and specific antibody-secreting cells among peripheral blood lymphocytes primed during provocation by milk antigens, giving indirect evidence of local immune response in the gut. Patients with persistent cow milk allergy (n = 13) had milder reactions at rechallenge than they had shown at the time of diagnosis. Numbers of immunoglobulin-secreting cells in these patients increased significantly from a geometric mean (95% confidence interval) in the IgA class of 1570 (1009, 2445) to 2984 (1941, 4583) IgA-secreting cells/10(6) cells, in the IgG class of 1445 (1067, 1959) to 2740 (1698, 4425) IgG-secreting cells/10(6) cells, and in the IgM class of 842 (534, 1325) to 2235 (1429, 3495) IgM-secreting cells/10(6) cells. By contrast, in patients (n = 24) who had acquired cow milk tolerance, the number of immunoglobulin-secreting cells did not increase during provocation. The total number of IgA-secreting cells before rechallenge was significantly higher than it had been before the initial challenge. The patients who acquired cow milk tolerance also had specific antibody-secreting cells of IgA isotype before the second challenge. These results indicate that in cow milk allergy the ability to mount a local immune response against cow milk antigens, particularly in the IgA class, is related to the suppression of clinical sensitivity.
Isolauri
E
E
Department of Pediatrics, University of Tampere, Finland.
Suomalainen
H
H
Kaila
M
M
Jalonen
T
T
Soppi
E
E
Virtanen
E
E
Arvilommi
H
H
D000818:Animals; D000906:Antibodies / Q000032:analysis; D000921:Antibody-Producing Cells / Q000276:immunology; D002364:Caseins / Q000276:immunology; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D000939:Epitopes; D005500:Follow-Up Studies; D006801:Humans; D007108:Immune Tolerance; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D007768:Lactalbumin / Q000276:immunology; D007782:Lactoglobulins / Q000276:immunology; D008892:Milk / Q000009:adverse effects; D016269:Milk Hypersensitivity / Q000097:blood / Q000178:diet therapy / Q000276:immunology* / Q000503:physiopathology; D012710:Serum Albumin, Bovine / Q000276:immunology
D000906:Antibodies; D002364:Caseins; D000939:Epitopes; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007782:Lactoglobulins; D012710:Serum Albumin, Bovine; D007768:Lactalbumin