title: B-cell epitopes as a screening instrument for persistent cow's milk allergy.
abstract: BACKGROUND
  Cow's milk is one of the most common causes of food allergy in the first years of life. We recently defined IgE-binding epitopes of all 6 major cow's milk proteins (alpha(s1)-, alpha(s2)-, beta-, and kappa-casein; alpha-lactalbumin; and beta-lactoglobulin) and had some evidence suggesting that IgE antibodies from patients with persistent cow's milk allergy (CMA) recognize different epitopes on cow's milk proteins than do those from patients who were likely to outgrow their allergy.
  
  
  OBJECTIVE
  In this study we sought to assess whether recognition of IgE antibodies of certain epitopes of cow's milk proteins would clearly separate the patients with life-long CMA from those who will become clinically tolerant to cow's milk.
  
  
  METHODS
  According to the known IgE-binding regions of cow's milk proteins, 25 decapeptides of alpha(s1)-casein, alpha(s2)-casein, kappa-casein, alpha-lactalbumin, and beta-lactoglobulin, comprising the core epitopes, were synthesized on a cellulose-derivatized membrane. Sera from 10 patients with persistent CMA and 10 patients who subsequently outgrew their milk allergy were used to investigate the differences in epitope recognition.
  
  
  RESULTS
  Five IgE-binding epitopes (2 on alpha(s1)-casein, 1 on alpha(s2)-casein, and 2 on kappa-casein) were not recognized by any of the patients with transient CMA but showed binding by the majority of the patients with persistent allergy. The presence of IgE antibodies against at least 1 of 3 epitopes (amino acid [AA] 123-132 on alpha(s1)-casein, AA 171-180 on alpha(s2)-casein, and AA 155-164 on kappa-casein) identified all patients with persistent CMA.
  
  
  CONCLUSIONS
  The presence of IgE antibodies to distinct allergenic epitopes of cow's milk proteins can be used as a marker of persistent CMA. Prospective studies are needed to investigate the usefulness of these informative epitopes in predicting life-long CMA in young children.
authors.affiliation: Division of Pediatric Allergy and Immunology, Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, USA.
authors.forename: Kirsi-Marjut
authors.initials: KM
authors.lastname: Järvinen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.forename: Leticia
authors.initials: L
authors.lastname: Vila
authors.forename: Pantipa
authors.initials: P
authors.lastname: Chatchatee
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Busse
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
mesh_terms: D000293:Adolescent; D000818:Animals; D002364:Caseins / Q000276:immunology*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D018985:Epitopes, B-Lymphocyte / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D007768:Lactalbumin / Q000276:immunology*; D007782:Lactoglobulins / Q000276:immunology*; D008403:Mass Screening; D008892:Milk / Q000009:adverse effects / Q000276:immunology*; D016269:Milk Hypersensitivity / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D010455:Peptides / Q000276:immunology
chemical_list: D002364:Caseins; D018985:Epitopes, B-Lymphocyte; D007782:Lactoglobulins; D010455:Peptides; D007073:Immunoglobulin E; D007768:Lactalbumin