Antibody Production to Milk Proteins in the Jejunal Mucosa of Children with Cow's Milk Protein Intolerance

Abstract

Summary A direct immunofluorescent technique with fluorescein-labeledantigens was used to examine the jejunal mucosa for specific antibody production in 23 children aged 2-25 months referred for diagnostic biopsy. Plasma cells containing antibodies to p-lactoglobulin (PLG) or bovine serum albumin (BSA) were present in I1 of 16 biopsies from patients with cow's milk protein intolerance (CMPI) but only one of eight controls, all on a diet containing cow's milk. Antibody-containing cells (ACC) constituted approximately 0.5-5% of the total (IgA + IgM) plasma cell population. In children with CMPI there may be gastrointestinal symptoms only, or these may be combined with other allergic manifestations such as eczema or asthma. In many CMPI children diagnostic tests for allergy-skin prick tests or RAST-are negative and the serum IgE is not raised (7, 11,20). This is especially so in those children with only gastrointestinal symptoms. But challenge with cow's milk often produces profound changes in the small intestinal mucosa, including villous atrophy of varying degree (9,10,12,34) and increased numbers of eosinophils (41) intra-epithelial lymphocytes (40) and plasma cells (10,21,33,34). It has not been established whether the increase in plasma cells is just part of a generalized, non-specific response of the immune system to antigenic stimulation (23, 37) or whether it represents a specific response to milk-protein antigens at the point of entry.In order to study the mucosal immune response to bovine milk proteins we have developed a simple direct immunofluorescent technique for the presence of plasma cells containing specific antibody to two bovine milk proteins, PLG and BSA. Brief, preliminary reports of this work have been published (16,27). MATERIALS AND METHODSPatients. Twenty-three children, aged 2-25 months, had been routinely referred to us for diagnostic jejunal biopsy. Informed consent to carry out this procedure was obtained from the parents.In 15 children a diagnosis of CMPI was made, based on a history of vomiting, diarrhoea, and weight loss (or exacerbation of eczema in atopic children) when on CM and improvement when on a CM-free diet. Details of presenting symptoms, dietary history, and results of challenges are given in Table 1. Four of these fifteen patients had additional allergies: to eggs (Nos. 6, 13, and 15), chicken, fish, and antibiotics (No. 11). Five of the fifteen had atopic symptoms such as eczema (Nos. 2, 8 and 13), asthma (NO. 13), and urticaria (No. 6). Five patients (Nos. 4, 5, 9, 10 and 11) were challenged with CM at the time of investigation, and had pre-and postchallenge biopsies as previously described (34); patient No. 4 had a second challenge at age 18 months. In this group a total of 23 biopsies were performed, 16 while the patient was taking CM and 7 while the patient was on a CM-free diet.Eight children whose symptoms could not be related to consumption of CM served as the control group. (Table 2). All were receiving CM at the time of jejunal biopsy.Biopsy specimens. Upper jej...

In vitro digestion methods for assessing the effect of food structure on allergen breakdown

“…Circumstantial evidence that intact food proteins or peptide fragments cross the gut barrier is offered by the presence in normal individuals of antibodies to a wide range of food proteins, such as b-lactoglobulin (b-Lg), in the circulation [5] and the jejeunal mucosa [6]. The presence of proteins, such as ovalbumin, in the blood of individuals after consumption of egg, also supports the premise that intact proteins, albeit in small quantities, can enter the body [7].…”

The Excretion of IgE with Feces from Healthy Individuals and from Others with Allergy and Diseases Affecting the Intestinal Tract

“…Further evidence in favor of the argument that IgE in feces is represented by such a resistant fragment is our find ing that a trypsin inhibitor did not influence the IgE concentrations when added to fresh feces. It is, there fore, unlikely that fecal IgE excreted into the gut lu men from the IgE-containing plasma cells which re side in the gut mucosa [3,II,12], had been falsely re duced because of rare passages of stools.…”

Immunoglobulin E in Feces of Children with Intestinal <i>Ascaris lumbricoides</i> Infestation

“…We have previously shown that diarrhea in itself will not lead to significantly in creased fecal IgE concentrations [12], The diarrhea of several of the ascaris-infected children could there fore not explain the findings. Thus, it seems that the ascaris worm, like some food allergens [20], can elicit a marked IgE response in the gut.…”