原標(biāo)題：
　　牛奶和牛奶組份特異性IgE ImmunoCAP檢測的一致性
　?、倌康?確定牛奶特異性IgE ImmunoCAP檢測與IgE抗體對牛奶過敏牛奶蛋白組份的反應(yīng)是否一致。②方法:對30例(6-16歲)牛奶過敏患兒的血清【其中20例接受牛奶口服免疫治療（MOIT）】進行Phadia ImmunoCAP檢測，檢測血清中牛奶（f 2)特異性IgE抗體，α-乳白蛋白-(ALA)、β-乳球蛋白-(BLG)、酪蛋白-(CAS)特異性IgE抗體水平。將血清抗牛奶IgE水平與血清抗α-乳白蛋白、β-乳球蛋白、酪蛋白IgE水平(kUa/L)的總和進行比較。偏差/不準(zhǔn)確性的評估方法是偏離理想比率1.0的程度。所有IgE抗體水平>50 kUa/L的樣本稀釋后重新分析，以確保準(zhǔn)確性。③結(jié)果:假設(shè)IgE抗ala - blg - cas的總和能準(zhǔn)確反映或可能低估牛奶特異性IgE，MOIT前血清抗全奶IgE/抗ala - blg - cas IgE的總和比值為2.17-1.74 (n = 2;高估可能是由于IgE anti-BSA/乳鐵蛋白缺失所致），1.04-0.90 (n = 3;相等）和0.77-0.42 (n = 25，低估)。在MOIT治療的受試者中，抗牛奶IgE/IgE抗ala - blg - cas比值在MOIT治療的一年內(nèi)基本保持不變，盡管抗牛奶IgE的絕對水平出現(xiàn)波動，抗牛奶IgG顯著增加。④結(jié)論:患者依賴性偏差可發(fā)生，只檢測抗牛奶IgE可能低估IgE抗體與牛奶組份反應(yīng)的實際水平高達2.4倍。雖然少數(shù)病人的牛奶特異性 IgE抗體水平和牛奶組份特異性IgE總和之間的一致性較好，但大部分是被低估了，原因可能是由于牛奶 ImmunoCAP中組份含量不足，這或許與臨床有實質(zhì)的相關(guān)性。
延伸閱讀
JACI
Agreement of Total vs. Component Milk-Specific IgE ImmunoCAP Measurements
DOI: https://doi.org/10.1016/j.jaci.2008.12.1067
Abstract
RATIONALE: To determine the agreement between ImmunoCAP cow's milk-specific IgE measurements and IgE antibody responses to individual allergic milk protein components.
METHODS: Sera from 30 children (6-16 years) with cow's milk allergy, 20 of which received milk oral immunotherapy (MOIT), were analyzed for IgE anti-cow's milk-(F2), alpha-lactalbumin-(ALA), beta-lactoglobulin-(BLG) and casein-(CAS) by Phadia ImmunoCAP. IgE anti-cow's milk levels alone were compared to the sum of individual IgE anti-alpha-lactalbumin;beta-lactoglobulin;casein in kUa/L. Bias/inaccuracy was assessed by deviation from an ideal ratio of 1.0. All IgE antibody levels >50 kUa/L were re-analyzed at dilutions to insure accuracy.
RESULTS: Assuming the sum of IgE anti-ALA-BLG-CAS should accurately reflect, or possibly underestimate the total milk specific IgE, IgE anti-milk/summed IgE anti-ALA-BLG-CAS ratios for pre MOIT sera ranged from 2.17-1.74 (n = 2; over-estimate possibly due to missing IgE anti-BSA/lactoferrin), 1.04-0.90 (n = 3; equivalence) and 0.77-0.42 (n = 25, underestimate). In MOIT-treated subjects, IgE anti-milk/IgE anti-ALA-BLG-CAS ratios remained generally constant within each subject over a year of MOIT despite fluctuations in absolute IgE anti-milk levels and marked increases in IgG anti-milk.
CONCLUSIONS: Patient-dependent bias can occur in which IgE anti-milk measurements alone may underestimate the actual level of IgE antibody reactive with milk components by up to 2.4 fold. While the concordance between the levels of milk-specific IgE antibody and the summed individual IgE anti-milk components is good for a minority of milk allergic patients, there is a majority where underestimation, possibly due to limited molar excess of components on the milk ImmunoCAP, may be substantial and clinically relevant.
All Author:
J. BogdanovicJ.M. Skripak A.W. Burks R.A. WoodR.G. Hamilton0
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺。