PDF(Pubmed)
Abstract：
BACKGROUND: The basophil activation test is an emerging clinical tool in the diagnosis of cow\'s milk allergy (CMA). The aim was to assess the association between the basophil allergen threshold sensitivity to the major milk protein casein (casein-specific CD-sens), the levels of milk- and casein-specific Immunoglobulin E antibodies (IgE-ab), and the severity of allergic reactions at milk challenges.
METHODS: We enrolled 34 patients aged 5-15 (median 9) years who underwent a double-blind placebo-controlled milk-challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson\'s severity score. Venous blood was drawn before the DBPCMC. Milk- and casein-specific IgE-ab were analyzed. Following in vitro stimulation of basophils with casein, casein-specific CD-sens, was determined.
RESULTS: Thirty-three patients completed the DBPCMC. There were strong correlations between casein-specific CD-sens and IgE-ab to milk (rs = 0.682, p < .001), and between casein-specific CD-sens and IgE-ab to casein (rs = 0.823, p < .001). There was a correlation between the severity of the allergic reaction and casein-specific CD-sens level (rs = 0.395, p = .041) and an inverse correlation between casein-specific CD-sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (rs = -0.418, p = .027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein-specific CD-sens, 23% had negative casein-specific CD-sens, and 10% were declared non-responders.
CONCLUSIONS: Two thirds of those reacting at the DBPMC had positive casein-specific CD-sens, but reactions also occurred despite negative casein-specific CD-sens. The association between casein-specific CD-sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate.
METHODS: We enrolled 34 patients aged 5-15 (median 9) years who underwent a double-blind placebo-controlled milk-challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson\'s severity score. Venous blood was drawn before the DBPCMC. Milk- and casein-specific IgE-ab were analyzed. Following in vitro stimulation of basophils with casein, casein-specific CD-sens, was determined.
RESULTS: Thirty-three patients completed the DBPCMC. There were strong correlations between casein-specific CD-sens and IgE-ab to milk (rs = 0.682, p < .001), and between casein-specific CD-sens and IgE-ab to casein (rs = 0.823, p < .001). There was a correlation between the severity of the allergic reaction and casein-specific CD-sens level (rs = 0.395, p = .041) and an inverse correlation between casein-specific CD-sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (rs = -0.418, p = .027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein-specific CD-sens, 23% had negative casein-specific CD-sens, and 10% were declared non-responders.
CONCLUSIONS: Two thirds of those reacting at the DBPMC had positive casein-specific CD-sens, but reactions also occurred despite negative casein-specific CD-sens. The association between casein-specific CD-sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate.
摘要：
背景：嗜碱性粒细胞活化试验是诊断牛奶过敏（CMA）的新兴临床工具。目的是评估嗜碱性粒细胞过敏原阈值敏感性与主要乳蛋白酪蛋白（酪蛋白特异性CD-sens）之间的关联。牛奶和酪蛋白特异性免疫球蛋白E抗体（IgE-ab）的水平，以及牛奶挑战时过敏反应的严重程度。
方法：我们招募了34名年龄在5-15岁（中位数为9岁）的患者，这些患者在纳入口服CMA免疫治疗研究之前接受了双盲安慰剂对照牛奶激发（DBPCMC）作为筛查。使用Sampson的严重程度评分对DBPCMC处的过敏反应的严重程度进行分级。在DBPCMC之前抽取静脉血。分析乳-和酪蛋白-特异性IgE-ab。用酪蛋白体外刺激嗜碱性粒细胞后，酪蛋白特异性CD-sens,已确定。
结果：33例患者完成了DBPCMC。酪蛋白特异性CD-sens和IgE-ab与牛奶之间有很强的相关性（rs=0.682，p<.001），以及酪蛋白特异性CD-sens和针对酪蛋白的IgE-ab之间(rs=0.823,p<.001)。过敏反应的严重程度与酪蛋白特异性CD-sens水平之间存在相关性（rs=0.395，p=.041），而酪蛋白特异性CD-sens水平与患者在DBPCMC中反应的乳蛋白的累积剂量之间存在负相关（rs=-0.418，p=.027）。在DBPCMC出现过敏反应的30名患者中，67%的酪蛋白特异性CD-sens阳性，23%的酪蛋白特异性CD-sens阴性，10%被宣布为无应答者。
结论：在DBPMC中反应的三分之二具有阳性酪蛋白特异性CD-sens，但尽管酪蛋白特异性CD-sens阴性，也发生了反应。酪蛋白特异性CD-sens与过敏反应的严重程度和乳蛋白的累积剂量之间的关联，分别,是温和的。
方法：我们招募了34名年龄在5-15岁（中位数为9岁）的患者，这些患者在纳入口服CMA免疫治疗研究之前接受了双盲安慰剂对照牛奶激发（DBPCMC）作为筛查。使用Sampson的严重程度评分对DBPCMC处的过敏反应的严重程度进行分级。在DBPCMC之前抽取静脉血。分析乳-和酪蛋白-特异性IgE-ab。用酪蛋白体外刺激嗜碱性粒细胞后，酪蛋白特异性CD-sens,已确定。
结果：33例患者完成了DBPCMC。酪蛋白特异性CD-sens和IgE-ab与牛奶之间有很强的相关性（rs=0.682，p<.001），以及酪蛋白特异性CD-sens和针对酪蛋白的IgE-ab之间(rs=0.823,p<.001)。过敏反应的严重程度与酪蛋白特异性CD-sens水平之间存在相关性（rs=0.395，p=.041），而酪蛋白特异性CD-sens水平与患者在DBPCMC中反应的乳蛋白的累积剂量之间存在负相关（rs=-0.418，p=.027）。在DBPCMC出现过敏反应的30名患者中，67%的酪蛋白特异性CD-sens阳性，23%的酪蛋白特异性CD-sens阴性，10%被宣布为无应答者。
结论：在DBPMC中反应的三分之二具有阳性酪蛋白特异性CD-sens，但尽管酪蛋白特异性CD-sens阴性，也发生了反应。酪蛋白特异性CD-sens与过敏反应的严重程度和乳蛋白的累积剂量之间的关联，分别,是温和的。
