Basophil reactivity, wheal size, and immunoglobulin levels distinguish degrees of cow's milk tolerance

Abstract

Background In our previous study, about 75% of cow’s milk-allergic children tolerated baked-milk products, which improved their prognosis and quality of life. Objective We sought to identify biomarkers of varying degrees of clinical tolerance among a cohort of cow’s milk-allergic children. Methods 132 subjects were initially classified as baked-milk-reactive, baked-milk-tolerant or “outgrown milk allergy” based on oral food challenges. The baked-milk tolerant group was then divided into 3 groups based upon the amount and degree of heat-denatured milk protein that they could tolerate. Serum was analyzed for allergen-specific IgE and IgG4, basophil reactivity was assessed in whole blood stimulated with serial 10-fold dilutions of milk protein, and prick skin tests were performed to commercial milk extract. Activated basophils were defined using flow cytometry as CD63brightCD203c+CD123+HLA-DRdim/−CD41a− lineage−. Data were analyzed using the Jonckheere-Terpstra test. Results Significant differences across the five clinical groups were seen for median casein- and milk-specific IgE, casein-specific IgG4 and casein IgE/IgG4; milk-specific to non-specific basophil activation ratio, median basophil reactivity, and spontaneous basophil activation (CD203c expression following stimulation with RPMI); and milk PST wheal diameters. Casein- and milk-specific IgE, milk-specific basophil reactivity and milk prick skin test wheal diameter are all significantly greater among milk-allergic patients who react to baked-milk than among those who tolerate it. Conclusions The majority of milk-allergic patients are able to tolerate some forms of baked-milk in their diets. Different phenotypes of cow’s milk-allergic children can be distinguished by casein- and milk-specific IgE, milk-specific basophil reactivity, and milk prick skin test mean wheal diameters. Spontaneous basophil activation is greater among patients with more severe clinical milk reactivity.

A Case Report of an African Infant with Cow Milk Allergy and Extensive Atopic Skin Disorders

“…According to epidemiological data, the prevalence of food allergy cases is estimated at 8% in the USA, with 38.7 % of the patients having a history of severe allergic reactions and 30.4 % have multiple food allergies [4]. With the exception of milk many children exhibit significant allergic reactions after ingestion of wheat, milk and shellfish [4,5].…”

“…The allergic response in infants receiving cow milk is well documented and quite often in combination with the occurrence of gastrointestinal symptoms [3,4]. According to epidemiological data, the prevalence of food allergy cases is estimated at 8% in the USA, with 38.7 % of the patients having a history of severe allergic reactions and 30.4 % have multiple food allergies [4].…”

“…According to epidemiological data, the prevalence of food allergy cases is estimated at 8% in the USA, with 38.7 % of the patients having a history of severe allergic reactions and 30.4 % have multiple food allergies [4]. With the exception of milk many children exhibit significant allergic reactions after ingestion of wheat, milk and shellfish [4,5]. In a study conducted in Australia, the infants who had a positive skin test, with appearance wheal size greater than 1 mm in one or more foods (raw egg, peanut, sesame, shellfish or cow's milk), had also oral sensitization in various foods including raw egg, peanuts or sesame.…”

Concerning Diet Duration at Cow’s Milk Protein Allergy. How and When Should Dairy Products Be Introduced Again?

“…А у детей, которые не переносят ни сырое, ни тер-мически обработанное молоко, повышены уровень sIgE к БКМ и казеину, а также показатель активации базо-филов. Размер волдыря при кожном тестировании у них также больше [48].…”

“…Поскольку высокая температура в значительной сте-пени разрушает конформационные части макромолекул антигена, дети с IgE к этим эпитопам могут переносить кипяченое молоко. В тех случаях, когда IgE связывают неконформационные антигенные детерминанты, толе-рантности к кипяченому молоку не формируется [48].…”