Immunoglobulin E and Immunoglobulin G4 Antibodies to Cow's Milk in Children with Cow's Milk Allergy

Authors:
  • BBB Björkstén
    B Björkstén
  • SAS Ahlstedt
    S Ahlstedt
  • FBF Björkstén
    F Björkstén
  • BCB Carlsson
    B Carlsson
  • SFS P Fällström
    S P Fällström
  • KJK Juntunen
    K Juntunen
  • MKM Kajosaari
    M Kajosaari
  • AKA Kober
    A Kober
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Abstract
The presence of cow's milk specific antibodies of immunoglobulin E and G4 classes were studied in 47 children with a positive clinical history of cow's milk allergy. The children were challenged with cow's milk orally. The clinical diagnosis was verified by immediate reactions in 25 patients while 22 had late reactions or were provocation test negative in spite of the clinical history. There was no relation between levels of cow's milk specific IgG4 antibodies and provocation test result, i.e. neither with immediate or late reactions. Total IgF. Was elevated above + 1 SD for age in 31 41 tested patients. Of these, 29 had immediate type reactions to cow's milk wheat flour and/or egg white, while only two of 10 children with IgE of less than +1 SD had a demonstrable allergy to any of these foods. The sensitivity was 80%. Specific IgE antibodies to cow's milk were demonstrated in 11 of 14 children with immediate reactions and in three of 15 who were provocation test negative or had only late reactions. This means a sensitivity of 79% and a specificity of 80%. At least had only late reactions. This means a sensitivity of 79% and a specificity of 80%. At least one of the four patients with specific IgE but negative provocation test result had earlier shown an immediate reaction when challenged with cow's milk indicating that the specific IgE antibodies were not truly “false” positive reactions but a consequence of previous allergy. Our results confirm an association between elevated total serum IgE and food allergy and an association between positive RAST to cow's milk and positive provocations in young children. We did not find any evidence for specific IgE‐1 antibodies playing a role in these patients.

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