Abstract
ABSTRACT
The heterogeneity of clinical atopic symptoms complicates the simultaneous detection and therapy of food hypersensitivity. Interleukin 4 (IL-4) produced by activated T lymphocytes can increase mast cell numbers or IgE production. Fifteen patients (11 children and 4 adults), ages 20 months to 42 years, with atopic dermatitis, asthma, or rhinitis were evaluated for atopic disease and food hypersensitivity for eventual entry into a double-blind controlled food challenge by a careful history, physical examination, prick skin tests, or specific IgE to inhalant and food allergens. Gastrointestinal symptoms and coexistence of atopic dermatitis with house dust sensitivity was observed in 7 patients. Serum IL-4 was assayed in duplicate by a sensitive monoclonal ELISA. Levels before dietary elimination ranged from 3 to 21 ng/ml, with mean levels of 9.8 ± 2.3 ng/ml, and levels after dietary elimination ranged from <0.1 to 6 ng/ml, with mean levels of 2.5 ± 0.86 ng/ml in 6 patients. Levels in 4 of 6 normal controls were undetectable, and the mean level was 0.73 ± 0.56 ng/ml. Dietary modification in 11 patients (6 pediatric and 5 adults) improved cutaneous and gastrointestinal symptoms, and all patients had decreased IL-4 levels after dietary elimination. The mean percentage of IL-4 decreased in 67%, correlating with clinical scores. Cytokine production from food antigen-stimulated T cells showed an inverse correlation with serum IL-4. Lymphocyte proliferative responses in all patients tested postdietary elimination for T cell cytokine production were inhibited by anti-IL-4.
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