LOCAL IMMUNE RESPONSE MEASURED BY BLOOD LYMPHOCYTES REFLECTS THE CLINICAL REACTIVITY OF CHILDREN WITH COW'S MILK ALLERGY

Abstract

To investigate the intestinal immune responses during a diagnostic milk provocation in patients (mean age 13.5 months) with cow's milk allergy (CMA), tola) immunoglobulin-secreting cells (ISCs) and specific antibody-secreting cells (ASCs) from peripheral blood samples were assessed by ELISA plaque assay (ELISPOT). Fifteen patients had acute urticarial skin eruptions, 8 patients had slow onset of eczema, and 15 patients showed symptoms from the gastrointestinal tract A significant increase in IgM secreting cells (geometric means with [95 % confidence intervals]) from 382.2 [265, 552] to 621.4 [381, 1013]/10⁶ cells; t = 2.87, p < 0.01 but not IgA- and IgG-secreting cells was associated with acute urticaria. In patients with eczematous skin eruptions and gastrointestinal symptoms the response involved all these immunoglobulin isotypes. The magnitude of the post-challenge ISC responses in patients with gastrointestinal symptoms in IgM class (from 657.9 [428,1012] to 3544.0 [1696, 7406]/10⁶ cells; t = 4.44, p < 0.001) and IgA class (from 974.6 [590, 1610] to 2482.4 [1528, 4028]/10⁶ cells, t = 3.99. p = 0.001) significantly exceeded that of the patients with cutaneous symptoms. Notwithstanding the distinct increase in the total number of ISCs, the ASC response specifically directed against beta-lactoglobulin and alfa-casein was small and inconsistent. In patients with acute urticaria no antigen-specific response was found, and in patients with eczema and gastrointestinal symptoms it was restricted to IgM isotype. These findings indicate that immune exclusion of antigens is defective in CMA. The quality and extent of the local immune response varied in the three reaction types, suggesting that different immunopathogenic mechanisms are operative in CMA.

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