title: The time-course of milk antigen-induced TNF-alpha secretion differs according to the clinical symptoms in children with cow's milk allergy.
abstract: BACKGROUND
  TNF-alpha secretion by blood mononuclear cells stimulated with cow's milk proteins is significantly higher in infants with active cow's milk allergy (CMA) manifested by digestive symptoms than in children who have recovered from CMA.
  
  
  OBJECTIVE
  The current study was undertaken to analyze the kinetics of TNF-alpha secretion and to evaluate the usefulness of the measurement of TNF-alpha release in whole blood cultures in the prediction of clinical outcome after milk challenge.
  
  
  METHODS
  Blood samples were obtained from 83 children maintained on a cow's milk-free diet and examined just before a cow's milk provocation. Children were divided into 4 groups according to clinical outcome: group I (active CMA with cutaneous symptoms), group II (active CMA with predominantly digestive symptoms), group III (children recovered from CMA), and group IV (control). The kinetics of TNF-alpha secretion was measured in blood cultured for 1 to 5 days at different cow's milk protein concentrations.
  
  
  RESULTS
  On day 1 TNF-alpha secretion was significantly higher in group I (485 [453] pg/mL, mean [SD], P <.005) and in group II (269 [102] pg/mL, P <. 005) than that observed in groups III and IV (149 [95] and 87 [71] pg/mL, respectively). Then TNF-alpha was rapidly degraded and a second peak of secretion was observed on day 5 but only in group II (278 [221] pg/mL), whereas in groups I, III, and IV a low secretion was observed (70 [61], 45 [40], and 11 [12] pg/mL, respectively, P <. 02).
  
  
  CONCLUSIONS
  These results show that the pattern of TNF-alpha secretion in response to cow's milk proteins is different in CMA infants with cutaneous or digestive symptoms and suggest that TNF-alpha release might predict clinical relapse on challenge.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale E9925, Faculté de Médicine Necker-Enfants malades, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Benlounes
authors.forename: C
authors.initials: C
authors.lastname: Candalh
authors.forename: P
authors.initials: P
authors.lastname: Matarazzo
authors.forename: C
authors.initials: C
authors.lastname: Dupont
authors.forename: M
authors.initials: M
authors.lastname: Heyman
mesh_terms: D000485:Allergens / Q000276:immunology*; D004032:Diet; D004064:Digestive System / Q000276:immunology; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008297:Male; D016269:Milk Hypersensitivity / Q000276:immunology*; D008894:Milk Proteins / Q000276:immunology*; D012867:Skin / Q000276:immunology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D000485:Allergens; D008894:Milk Proteins; D014409:Tumor Necrosis Factor-alpha