原標(biāo)題：與牛奶過(guò)敏反應(yīng)或乳糖-α-1、3-乳糖過(guò)敏病人相比，嗜酸細(xì)胞性食管炎患者中的過(guò)敏原組份特異性IgG4優(yōu)先升高
　?、偈澄镞^(guò)敏的發(fā)生率正在增加，包括具有明顯獨(dú)特病理生理的疾病，如嗜酸細(xì)胞性食管炎(EoE)、牛奶過(guò)敏和半乳糖-1,3-半乳糖(alpha-gal)過(guò)敏。雖然包括IgG4在內(nèi)的其它抗體亞型的作用尚不清楚，但I(xiàn)gE在這些疾病中的作用已經(jīng)得到了很好的研究②在這里，我們?cè)u(píng)估了來(lái)自弗吉尼亞大學(xué)的隨機(jī)選擇的患有EoE、牛奶過(guò)敏反應(yīng)和α-半乳糖肉類(lèi)過(guò)敏患者血清中的相關(guān)組份過(guò)敏原特異性IgG4的水平。IgG4和IgE水平采用商業(yè)化的免疫cap技術(shù)或生物素化抗原偶聯(lián)鏈霉親和素免疫吸附測(cè)定法。③與牛奶過(guò)敏反應(yīng)或非過(guò)敏對(duì)照組相比，EoE患者中牛奶組份過(guò)敏原Bos d4 (α-乳白蛋白)和Bos d5 (β-乳球蛋白)特異性IgG4平均水平比牛奶過(guò)敏反應(yīng)組或非牛奶過(guò)敏對(duì)照組高10倍。這也與EoE與牛奶過(guò)敏反應(yīng)之間IgE/IgG4比值的顯著變化有關(guān)。與牛奶過(guò)敏反應(yīng)的趨勢(shì)相似，但與EoE相反，α-半乳糖過(guò)敏患者的相關(guān)過(guò)敏原組份半乳糖-α-1、3-半乳糖特異性IgE水平相對(duì)于特異性IgG4是顯著升高的。④與其他食物過(guò)敏(包括牛奶過(guò)敏和α-半乳糖過(guò)敏，主要是IgE反應(yīng))相比，EoE中相關(guān)過(guò)敏原特異性IgG4的水平獨(dú)特地升高。這項(xiàng)使用特定組份檢測(cè)的初步工作是建立在先前的研究基礎(chǔ)之上的，這些研究表明IgG4在EoE中優(yōu)先升高。研究還顯示，盡管臨床反應(yīng)延遲，α-半乳糖過(guò)敏在IgE、IgG4方面的特征類(lèi)似于其它速發(fā)型超敏反應(yīng)。
延伸閱讀
JACI:IgG4 Component Allergens Are Preferentially Increased in Eosinophilic Esophagitis As Compared to Patients with Milk Anaphylaxis or Galactose-Alpha-1,3-Galactose Aller
DOI: https://doi.org/10.1016/j.jaci.2015.12.780
Abstract：
Rationale
Incidence of food allergy is increasing, including diseases with apparently unique pathophysiologic pathways such as eosinophilic esophagitis (EoE), milk anaphylaxis and galactose-alpha-1,3-galactose (alpha-gal) allergy. The role of IgE in these diseases has been well studied, though the contribution of other antibody subtypes, including IgG4, is less clear.
Methods
Here we assessed IgG4 levels to relevant component allergens from sera banked at the University of Virginia in randomly selected patients carrying diagnoses of EoE, milk anaphylaxis and alpha-gal meat allergy. IgG4 and IgE levels were measured with ImmunoCap technology using commercial assays or biotinylated antigen coupled to streptavidin immunosorbent.
Results
IgG4 geometric mean levels to milk component allergens Bos d 4 (α-lactalbumin) and Bos d 5 (β-lactoglobulin) were >10 fold higher in EoE patients than milk anaphylaxis or non-allergic controls. This also correlated with a pronounced shift in the IgE/IgG4 ratio between EoE and milk anaphylaxis. Similar to the trend seen in milk anaphylaxis but contrary to EoE, alpha-gal patients had marked relative increase in IgE versus IgG4 levels to the relevant allergen galactose-alpha-1,3-galactose.
Conclusions
Levels of IgG4 to relevant allergen are uniquely elevated in EoE as compared to other food allergies, including milk anaphylaxis and alpha-gal, where IgE is the dominant response. This preliminary work using component-specific testing builds on prior studies demonstrating that IgG4 is preferentially elevated in EoE. It also highlights that despite a delayed clinical response alpha-gal shares an IgE-to-IgG4 signature similar to other immediate hypersensitivity reactions.
All Authors
Jeffrey M. Wilson  Alexander J. Schuyler Anubha Tripathi Elizabeth A. Erwin
Scott P. Commins Thomas A.E. Platts-Mills
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專(zhuān)業(yè)診斷、治療、預(yù)防的共享平臺(tái)。