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　　原标题：血清总IgG4和牛奶蛋白特异性IgG4测定在嗜酸细胞性食管炎儿童中的诊断作用：与一个未经选择的出生队列的比较
　　①嗜酸性食管炎(EoE)与常见食物，尤其是牛奶特异性IgG4抗体(sIgG4)有关。对牛奶或其它食物特异性IgG4在一般人群中的流行病学情况了解很少。因此，IgG4检测的诊断作用尚不清楚。②我们在弗吉尼亚大学(弗吉尼亚州夏洛茨维尔)或全国儿童医院(俄亥俄州哥伦布市)研究了67名通过食道活检诊断为EoE的儿童(中位年龄=11岁);101例未经任何疾病选择的出生队列作 (中位年龄=12.8岁)(Viva项目)和40例不相关的非过敏儿童(中位年龄=12岁) 作为为对照，这40例儿童没有食物特异性IgE抗体(sIgE)。ImmunoCAP.检测血清中牛奶蛋白(α-乳白蛋白、β-乳球蛋白、酪蛋白)sIgE、sIgG4和总IgG4 (tIgG4)。③儿童EoE患者和未经选择的对照组的牛奶的敏感率(sIgE≥0.10 IU/mL)分别是79%(n=53/67和22% (n=22/101)。 EoE患者的牛奶蛋白sIgG4的滴度高于未选择的对照组(p<0.001)。基于实验室值的tIgG4升高(p<0.01)和α-乳白蛋白、酪蛋白sIgG4升高(p<0.001)在EoE患者中比未选择的对照组更为常见。此外，EoE患者中牛奶蛋白(所有三种蛋白)sIgG4在tIgG4中所占比例均高于未选择的对照组(p<0.001)。EoE患者与非过敏对照组之间也存在类似的血清学差异。④在EoE患儿中，牛奶蛋白sIgG4 对tIgG4有显著影响。结果表明，牛奶蛋白sIgG4 滴度可用于EoE的诊断。
延伸阅读
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
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。