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　　原标题：嗜酸细胞性食管炎患儿中牛奶特异性IgG4
　　①过敏原特异性IgG4 (sIgG4)抗体通常与耐受性有关，但最近有人报道了成人嗜酸细胞性食管炎(EoE)患者中的病因相关食物特异性IgG4抗体。一般儿童人群中食物特异性IgG4的水平和流行病学情况还没有很好地确定。②我们试图通过对EoE患儿和未经选择的出生队列的儿童进行组分诊断来研究血清中sIgG4的含量，并探讨性别、年龄和牛奶摄入量对sIgG4水平的影响。③来自71例儿童EoE患者和210例未经选择的出生队列中的青春早期儿童（Viva工程）的血清，测定其以下食物特异性IgG4和特异性IgE的水平：主要牛奶蛋白（α-如白蛋白，β-乳球蛋白，酪蛋白）、小麦、大豆、鸡蛋、花生。④在EoE队列中，出现高滴度(≥10μg /ml)的牛奶蛋白sIgG4的情况比对照组更为普遍，优势比（odds ratios）达到5.5到8.4不等。在EoE患者中，牛奶蛋白sIgE水平大多为4 IU/mL或更少，因此sIgG4/sIgE的比值通常为10000或更高。根据年龄和牛奶摄入量进行调整，高滴度牛奶蛋白sIgG4与EoE密切相关，在男孩中，三种牛奶蛋白的优势比均大于20。⑤牛奶蛋白sIgG4在EoE患儿中常见，而且滴度高。虽然还不清楚这种反应是否具有致病性，但sIgG4水平表明这些抗体是导致EoE的局部免疫反应的一个重要特征。


　　延伸阅读
JACI  
Specific IgG4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis
https://doi.org/10.1016/j.jaci.2018.02.049
Abstract：
Background
Allergen-specific IgG4 (sIgG4) antibodies are often associated with tolerance, but sIgG4 antibodies to causally relevant foods have been reported recently in adults with eosinophilic esophagitis (EoE). Prevalence and levels of food sIgG4 are not well established in the general pediatric population.
Objective
We sought to investigate serum food sIgG4 with component diagnostics in children with EoE and children from an unselected birth cohort and to explore the effects of sex, age, and milk consumption on sIgG4 levels.
Methods
Sera from 71 pediatric patients with EoE and 210 early adolescent children from an unselected birth cohort (Project Viva) were assayed for sIgG4 and specific IgE (sIgE) to major cow's milk (CM) proteins (α-lactalbumin, β-lactoglobulin, and caseins) and to wheat, soy, egg, and peanut proteins.
Results
In the EoE cohort high-titer sIgG4 (≥10 μg/mL) to CM proteins was more common than in control sera and achieved odds ratios for EoE ranging from 5.5 to 8.4. sIgE levels to CM proteins were mostly 4 IU/mL or less in patients with EoE, such that sIgG4/sIgE ratios were often 10,000 or greater. When adjusted for age and milk consumption, high-titer sIgG4 to CM proteins was strongly associated with EoE, with an odds ratio of greater than 20 to all 3 CM proteins in boys.
Conclusions
sIgG4 to CM proteins are common and high titer in children with EoE. Although it is not clear that this response is pathogenic, sIgG4 levels imply that these antibodies are an important feature of the local immune response that gives rise to EoE.
All Authors：
Alexander J.SchuylerBS, BAa∗Jeffrey M.WilsonMD, PhDa∗AnubhaTripathiMDaScott P.ComminsMD, PhDbPrincess U.OgboguMDcPatrice G.KruzsewskiDOdBarrett H.BarnesMDeEmily C.McGowanMD, PhDaLisa J.WorkmanBAaJonasLidholmPhDfSheryl L.Rifas-ShimanMPHgEmilyOkenMD, MPHgDiane R.GoldMD, MPHhThomas A.E.Platts-MillsMD, PhDa‡Elizabeth A.ErwinMDi‡
　　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。