title: Maintenance of tolerance to cow's milk in atopic individuals is characterized by high levels of specific immunoglobulin G4.
abstract: BACKGROUND
  The central role of specific IgE in cow's milk allergy (CMA) is well documented. However, less is known about the function of other immunoglobulin isotypes in allergy and tolerance to cow's milk proteins (CMPs).
  
  
  OBJECTIVE
  To determine differences in the antibody responses that are associated with allergy and tolerance to cow's milk in allergic, atopic and non-atopic individuals of different age groups.
  
  
  METHODS
  Nineteen infants (<1 year), 18 children (6-14 years) and 41 adults (21-68 years) were included. Each age group was comprised of subjects with CMA, atopic individuals without a history of CMA and non-atopic subjects. Levels of specific IgE, IgG4, IgG1 and IgA to whole cow's milk and the six most abundant individual CMPs were determined in plasma by ELISA. For comparison, specific IgE and IgG4 were measured to ovomucoid and house dust mite (HDM) in individuals allergic for the respective allergens, and in atopic and non-atopic subjects without allergy.
  
  
  RESULTS
  In infants and children with CMA, alphas1-casein and beta-lactoglobulin induced the highest specific IgE response, whereas alphas1-casein was the most allergenic CMP in adult patients. Specific IgG4 and IgG1 responses were the highest to alphas1-casein and beta-lactoglobulin in all age groups, while kappa-casein and alpha-lactalbumin induced the highest levels of IgA. CMP-specific IgG4 was higher in atopic children and adults without CMA, as compared with non-atopic individuals. A similar difference between tolerant atopic and non-atopic subjects was observed for IgG4 specific to ovomucoid, whereas HDM-specific IgG4 was not detectable in these subjects.
  
  
  CONCLUSIONS
  Maintenance of tolerance to cow's milk in atopic children and adults without CMA is associated with elevated levels of specific IgG4, in combination with low specific IgE. The up-regulation of specific IgG4 in tolerant atopic individuals may be related to the type of allergen and its regular dose of exposure.
authors.affiliation: Department of Dermatology/Allergology, University Medical Center, Utrecht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Ruiter
authors.forename: E F
authors.initials: EF
authors.lastname: Knol
authors.forename: R J J
authors.initials: RJ
authors.lastname: van Neerven
authors.forename: J
authors.initials: J
authors.lastname: Garssen
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: A C
authors.initials: AC
authors.lastname: Knulst
authors.forename: E
authors.initials: E
authors.lastname: van Hoffen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000009:adverse effects; D002417:Cattle; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology*; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood*; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000276:immunology*; D008894:Milk Proteins / Q000009:adverse effects*; D010059:Ovomucin / Q000009:adverse effects; D011852:Radioallergosorbent Test; D015203:Reproducibility of Results; D015854:Up-Regulation
chemical_list: D039741:Antigens, Dermatophagoides; D007074:Immunoglobulin G; D008894:Milk Proteins; D010059:Ovomucin; D007073:Immunoglobulin E