②方法：我们对成功完成升级阶段的受试者在基线(治疗开始前)和升级阶段(200ml剂量)结束时进行了中期分析。在基线和200毫升剂量时评估唾液中牛奶蛋白组份(α-如白蛋白，β-乳球蛋白,酪蛋白)的特异性IgG4。③结果：所有三种牛奶蛋白的唾液IgG4水平从开始到200ml剂量的过程中总体呈上升趋势。α-乳白蛋白,β-乳球蛋白,和酪蛋白唾液IgG4平均浓度基线分别是0 ng / mL (SEM 0 ng / mL), 0.5 ng / mL (SEM 0.3 ng / mL),和177.4 ng / mL (SEM 126.1 ng / mL)。相比，在剂量为200毫升的提升阶段，三种蛋白的唾液IgG4平均浓度分别为:424.1 ng / mL (SEM 265.2 ng / mL), 1142 ng / mL (SEM 858.5 ng / mL),和3367 ng / mL (SEM 2443 ng / mL)。 ④结论：在IgE介导的儿童牛奶过敏中，牛奶OIT的成功升级阶段与唾液中牛奶蛋白特异性IgG4的增加有关。这表明，它可以作为儿童口服免疫治疗的一种潜在的非侵入性脱敏标记物。更大样本的进一步评估正在进行中。
Salivary IgG4 Increases during Milk Oral Immunotherapy
Cow’s milk allergy (CMA) is a frequent cause of severe allergic reactions and anaphylaxis in children. Oral immunotherapy (OIT) has shown promising results with immunological changes occurring during desensitization. Our team at the Research Institute of McGill University Health Centre has demonstrated an increase in serum IgG4 during the escalation and maintenance phases of milk OIT. We assessed the changes in salivary IgG4 during milk OIT, as a potential non-invasive biomarker of desensitization.
We performed an interim analysis at baseline (prior to the start of treatment) and at the end of escalation phase (200ml dose) of the milk OIT protocol in subjects who successfully completed the escalation phase. Milk protein component (α-lactalbumin, β-lactoglobulin, casein) -specific salivary IgG4 were evaluated at baseline and 200ml.
There was an overall increase in salivary IgG4 from baseline to 200ml for all three milk proteins. The mean salivary IgG4 concentration at baseline was 0 ng/mL (SEM 0 ng/mL), 0.5 ng/mL (SEM 0.3ng/mL), and 177.4 ng/mL (SEM 126.1ng/mL) for α-lactalbumin, β-lactoglobulin, and casein respectively; compared to the mean salivary IgG4 concentration at the 200ml dose of escalation phase: 424.1 ng/mL (SEM 265.2ng/mL), 1142 ng/mL (SEM 858.5ng/mL), and 3367 ng/mL (SEM 2443ng/mL) for α-lactalbumin, β-lactoglobulin, and casein respectively.
Successful escalation phase of milk OIT in IgE-mediated CMA in children is associated with an increase in salivary milk protein-specific IgG4. This suggests it could be used as a potential non-invasive biomarker of desensitization in OIT in children. Further assessment with a larger sample size is underway.
Bahar Torabi Oliver Schneide Duncan Lejtenyi
Moshe Ben-Shoshan Bruce D. Maze