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Immunological studies in cows' milk protein-sensitive enteropathy


Immunological studies in cows' milk protein-sensitive enteropathy



Archives of Disease in Childhood 56(1): 24-30



ISSN/ISBN: 0003-9888

PMID: 7193434

DOI: 10.1136/adc.56.1.24

Infants (55), aged between 1-13 mo. and who displayed persistent diarrhea were placed on a diet free of cows' milk protein. The clinical condition of the infants improved and 6-8 wk later each was challenged with low-lactose cows' milk. The following investigations were performed before and 24 h after provocation:jejunal biopsy, serum and duodenal juice levels of complement C3 and C4, C3-activator and IgA, G, M and D. Three groups were recognized on postchallenge with clinical symptoms histological changes in the jejunal mucosa: group 1 (n = 10 infants) with no clinical or mucosal abnormality, group 2 (n = 18 infants) with mucosal abnormalities but lacking clinical symptoms and group 3 (n = 27 infants) with mucosal abnormalities and clinical symptoms. In group 3 symptoms were delayed for over 24 h in 7 infants but in the remaining 20 infants symptoms appeared within 24 h. After provocation the serum IgG levels were decreased in 3 infants in group 1, 12 in group 2 and 17 in group 3. The mean serum IgA and IgM levels were higher in group 1 than in group 2 or 3; pre- and postchallenge mean serum Ig levels, complement and complement activator levels were equal in all 3 groups. A depletion of serum complement C3 level occurred in 4 (group 1), 4 (group 2) and 13 (group 3) infants 24 h after provocation with cows' milk. The fall in serum IgG was often associated with depletion of complement in serum. This suggests that in some infants, IgG-mediated complement-consuming immune reactions were involved in the development of the damage in the intestinal mucosa. After challenge, exudation of IgG and IgA occurred irrespective of the presence or absence of mucosal damage and was not always associated with the decrease in serum IgG concentration. Because of the variable conditions present in the intestinal lumen, the level of Ig in duodenal juice is apparently not a reliable measure of the local immune response. Levels of complement and Ig in serum or duodenal juice fail to provide help in the diagnosis of cows' milk protein-sensitive enteropathy.

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Accession: 005635198

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