原標(biāo)題：血清總IgG4和牛奶蛋白特異性IgG4測定在嗜酸細(xì)胞性食管炎兒童中的診斷作用：與一個未經(jīng)選擇的出生隊列的比較
　　①嗜酸性食管炎(EoE)與常見食物，尤其是牛奶特異性IgG4抗體(sIgG4)有關(guān)。對牛奶或其它食物特異性IgG4在一般人群中的流行病學(xué)情況了解很少。因此，IgG4檢測的診斷作用尚不清楚。②我們在弗吉尼亞大學(xué)(弗吉尼亞州夏洛茨維爾)或全國兒童醫(yī)院(俄亥俄州哥倫布市)研究了67名通過食道活檢診斷為EoE的兒童(中位年齡=11歲);101例未經(jīng)任何疾病選擇的出生隊列作 (中位年齡=12.8歲)(Viva項目)和40例不相關(guān)的非過敏兒童(中位年齡=12歲) 作為為對照，這40例兒童沒有食物特異性IgE抗體(sIgE)。ImmunoCAP.檢測血清中牛奶蛋白(α-乳白蛋白、β-乳球蛋白、酪蛋白)sIgE、sIgG4和總IgG4 (tIgG4)。③兒童EoE患者和未經(jīng)選擇的對照組的牛奶的敏感率(sIgE≥0.10 IU/mL)分別是79%(n=53/67和22% (n=22/101)。 EoE患者的牛奶蛋白sIgG4的滴度高于未選擇的對照組(p<0.001)。基于實驗室值的tIgG4升高(p<0.01)和α-乳白蛋白、酪蛋白sIgG4升高(p<0.001)在EoE患者中比未選擇的對照組更為常見。此外，EoE患者中牛奶蛋白(所有三種蛋白)sIgG4在tIgG4中所占比例均高于未選擇的對照組(p<0.001)。EoE患者與非過敏對照組之間也存在類似的血清學(xué)差異。④在EoE患兒中，牛奶蛋白sIgG4 對tIgG4有顯著影響。結(jié)果表明，牛奶蛋白sIgG4 滴度可用于EoE的診斷。
延伸閱讀
JACI  
The diagnostic utility of serum assays for total IgG4 and specific IgG4 antibodies to cow's milk proteins in children with eosinophilic esophagitis: Comparison with an unselected birth cohort
DOI: https://doi.org/10.1016/j.jaci.2016.12.108
Abstract:
Rationale
Eosinophilic esophagitis (EoE) is associated with specific IgG4 antibodies (sIgG4) to common foods, especially cow’s milk (CM). Little is known regarding the epidemiology of sIgG4 to CM or other foods in the general population. Thus, the diagnostic utility of IgG4 assays is unclear.
Methods
We studied 67 children (median age=11 years) diagnosed with EoE by esophageal biopsy at The University of Virginia (Charlottesville, VA) or Nationwide Children’s Hospital (Columbus, OH); 101 controls (median age=12.8 years) from a birth cohort unselected for any disease (Project Viva); and 40 unrelated non-allergic controls (median age=12 years) without specific IgE antibodies (sIgE) to foods. Sera were assayed for sIgE and sIgG4 to CM proteins (alpha-lactalbumin, beta-lactoglobulin, caseins) and total IgG4 (tIgG4) by ImmunoCAP.
Results
The prevalence of CM sensitization (sIgE ≥0.10 IU/mL) among the pediatric EoE patients and unselected controls was 79% (n=53/67) and 22% (n=22/101), respectively. The titers of sIgG4 to the CM proteins were higher in EoE patients than in unselected controls (p<0.001). Elevated tIgG4 based on laboratory values (p<0.01) and sIgG4 to alpha-lactalbumin and caseins (p<0.001) were more common in EoE patients compared to unselected controls. Furthermore, the mean sIgG4 to CM (all three proteins) as a percentage of tIgG4 was higher in EoE patients than in unselected controls (p<0.001). Similar serological differences between EoE patients and non-allergic controls were also observed.
Conclusions
Among children with EoE, sIgG4 to CM can significantly contribute to tIgG4. The results suggest that titer of sIgG4 to CM proteins could be incorporated into a diagnostic algorithm for EoE.
© 2016 Published by Elsevier Inc.
All Authors: Alexander J. Schuyler  Elizabeth A. Erwin Emily Oken Sheryl Rifas-Shiman Jonas Lidholm   Jeffrey Wilson  Anubha Tripathi Lisa J. Workman Diane R. Gold Thomas A.E. Platts-Mills
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺。