Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant
Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant
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DOI：
10.1067/mai.2001.111592
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发表时间：
2001-01-01
影响因子：
14.2
通讯作者：
Martín-Esteban, M
中科院分区：
文献类型：
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作者：
García-Ara, C;Boyano-Martínez, T;Martín-Esteban, M
背景：当诊断出对牛奶蛋白（CMP）有即时症状性超敏反应时，应建立使用替代配方的无奶饮食，因此准确诊断非常重要。
目的：本研究旨在通过使用牛奶及其主要蛋白质作为过敏原，找到能够区分过敏和耐受婴儿的特异性IgE抗体水平的最佳临界值。
方法：对170名1岁以下（平均4.8个月）的患者进行了一项前瞻性研究。这些患者在4年期间连续在我们的门诊就诊，且均是首次因摄入牛奶配方后出现提示即时超敏反应的症状。对所有儿童都进行了临床病史采集、牛奶及其蛋白质（α -乳白蛋白、β -乳球蛋白和酪蛋白）的点刺试验、使用与点刺试验相同过敏原的CAP系统FEIA测定特异性IgE抗体，以及按照诊断方案进行激发试验。还分析了点刺试验（临界值为3mm）和CAP系统在牛奶及其蛋白质特异性IgE不同临界值时的有效性。
结果：本研究中对CMP即时症状性超敏反应的患病率为44%。当在点刺试验中同时使用全脂牛奶及其主要牛奶蛋白时，阴性预测值非常高，阴性结果可排除97%患者的过敏情况。当分析牛奶特异性IgE的不同临界值时，2.5 KUA/L的阳性预测值为90%，5 KUA/L的阳性预测值为95%。
结论：在诊断婴儿对CMP的即时超敏反应时，皮肤试验阴性反应可排除大多数患者的过敏情况，如果点刺试验反应为阳性，牛奶特异性IgE水平可能有帮助。如果这些值为2.5 KUA/L或更高，由于其高阳性预测值（90%），不应进行激发试验。
Background: A milk-free diet with substitute formula should be established when immediate symptomatic hypersensitivity to cows' mills protein (CMP) is diagnosed, and therefore an accurate diagnosis is very important.Objective: This study aims to find the optimal cutoff values for specific IgE antibody levels that discriminate between allergic and tolerant infants by using cows' milk and its principal proteins as allergens.Methods: A prospective study was carried out on 170 patients under 1 year old (mean, 4.8 months). These patients were seen consecutively over a 4-year period in our outpatient clinic and for the first time because of a reaction suggesting immediate hypersensitivity after ingestion of cows' milk formula. A clinical history, prick test with cows' milk and its proteins (alpha -lactalbumin, beta -lactoglobulin, and casein), determination of specific IgE antibodies with the CAP system FEIA for the same allergens as for the prick test, and a challenge test according to the diagnostic protocol were performed in all of the children. A study of validity of the prick test (cutoff point, 3 mm) and CAP system by using different cutoff points in the specific IgE, values for cows' milk and its proteins were also analyzed.Results: Prevalence of immediate symptomatic hypersensitivity to CMP in this study was 44%. When both the whole milk and its principal milk proteins were used in the prick test, the negative predictive value was very high, and a negative value excluded allergy in 97% of the patients. When the different cutoff points of the specific IgE for milk were analyzed, 2.5 KUA/L, had a positive predictive value of 90% and 5 KUA/L had a positive predictive value of 95%.Conclusions: When diagnosing immediate hypersensitivity to CMP in infants, negative skin test responses exclude allergy in most of the patients, if the prick test response is positive, specific IgE levels for cows' milk may be helpful. If these values are 2.5 KUA/L or greater, the challenge test should not be performed because of its high positive predictive value (90%).