Differences in antigen-specific T-cell responses between infants with atopic dermatitis with and without cow’s milk allergy: Relevance of TH2 cytokines

Background: Cow’s milk is the most important food antigen in infancy and may lead to acute cutaneous symptoms and atopic dermatitis (AD). The role of circulating allergen-specific T cells in the pathogenesis of food-allergic skin symptoms is still under investigation. Objective: This study was designed to analyze the cow’s milk protein (CMP)–specific T-cell response at the clonal level in infants with AD and cow’s milk allergy (CMA) in comparison with infants with AD without CMA. Methods: We used an antigen-specific culturing system with autologous B cells as antigen-presenting cells to establish CMP-specific T-cell clones derived from PBMCs in infants with AD. T-cell reactivity, measured by using a lymphocyte stimulation test, and cytokine production, measured by using ELISA, was compared between infants with AD with and without CMA. Results: Both infants with and without allergy to cow’s milk had a CMP-specific T helper cell response directed against the major proteins in milk. Analysis of antigen-specific cytokine production showed that this response was TH2 skewed in infants with CMA, with production of high levels of IL-4, IL-5, and IL-13. In contrast, infants without CMA had a TH1-skewed response, with high levels of IFN-γ and low levels of IL-4, IL-5, and IL-13. Conclusion: These data confirm for the first time at the clonal level that food allergy in infants with AD is associated with production of TH2 cytokines by circulating antigen-specific CD4+ T cells, whereas tolerance to food antigens is associated with low levels of these cytokines. This suggests a key role for the T helper cell–derived TH2 cytokines in food allergy–related skin symptoms. (J Allergy Clin Immunol 2000;106:1155-62.)