Previous studies have shown that individuals that tolerate cow’s milk have higher levels of milk-specific IgG4 antibodies than those with a prolonged milk allergy [27,28], and it has been indicated that IgE and IgG4 antibodies combined might be used to predict tolerance development [29]. 6.6 kUA/L. The non-CMA group had significantly higher sIgG4 levels against all three milk allergens compared to the CMA group. This was most pronounced for casein-sIgG4 in non-CMA children without history of previous milk allergy. These children had significantly higher casein-sIgG4 levels compared to any other group, including the non-milk sensitized control children. Conclusions High levels of casein-sIgE antibodies are strongly associated with milk allergy in children and might be associated with prolonged allergy. Elevated casein-sIgG4 levels in milk-sensitized individuals on normal diet indicate a altered Th2 response. However, the protective role of IgG4 antibodies in milk allergy is usually unclear. strong class=”kwd-title” Keywords: IWP-2 casein, cow’s milk allergy, IgE, IgG4, ImmunoCAP Background Food allergies, described as adverse immune responses to food, are common and have increased in prevalence during the past decades. About 5% of the young children and 3-4% of the adults are affected today [1]. Milk, egg, peanut, tree nuts, fish, shellfish, wheat and soy are considered to cause most of the food adverse reactions [1]. Of these, cow’s milk is the most frequent food causing allergy among infants and young children with a prevalence ranging from 1 to about 7.5% [2,3]. Proper management of milk allergy is important due to the low but serious risk of anaphylaxis [4]. Fortunately most children recover spontaneously from their allergy and develop tolerance to cow’s milk until they reach 5 years of age [5,6]. The remaining children may have a prolonged cow’s milk allergy causing pain and limitations to their daily lives for many years [7]. A recent study indicates that this proportion of children with prolonged milk allergy might be larger than previously anticipated [8]. The most important allergens in cow’s milk are -lactalbumin (also called Bos d 4), -lactoglobulin (Bos d 5) and casein (Bos d 8) [2,9]. Milk can be separated into two fractions, the whey and the coagulum. Most known milk allergens are found IWP-2 in the milk whey including -lactalbumin and -lactoglobulin, while casein is present in the coagulum. Casein has been shown to be both more antigenic and allergenic than the whey proteins indicating its role as important milk allergen [10]. However, all milk proteins appear to be potential allergens and patients are often sensitized to several of them [11]. It has been shown that patients that are sensitized to several milk allergens tends to have a poor prognosis regarding outgrown of their milk allergy [12]. Diagnosis and management of food allergy include actions like initial avoidance of the suspected food allergen, skin prick testing and measuring of serum levels of food-specific IgE antibodies mostly using extract-based assessments. In Rabbit Polyclonal to UBE1L time, in order to confirm the diagnosis or to determine whether a reintroduction of the particular food is safe due to tolerance development, oral food challenges could be conducted [4]. Other diagnostic tools making it possible to earlier discriminate between prolonged and tolerated food allergies are desirable. We have earlier shown in wheat and egg allergy that specific IgE measurements could help the physician to provide better guidance to their patients and be a complement to food challenges [13,14]. Here, in order to study the clinical usefulness of specific antibodies in milk allergy, the concentrations of IgE antibodies to milk, and IgE and IgG4 antibodies to casein, -lactalbumin and -lactoglobulin were studied in sera from milk allergic and milk tolerant children. Methods Subjects Eighty-three children with a IWP-2 suspected IgE-mediated cow’s milk allergy (CMA) were IWP-2 enrolled in the study. The patients (male/female ratio, 55/28) ranged in age from 0.8 to 15.8 years (median: 3.5 years). All were milk sensitized as revealed by specific IgE em in.