Asthma and TNF variants in Chinese and Malays

Abstract

edema, cough, and dyspnea developed.The youth's pre-event meal 2 h earlier had included Parmesan, a cow's milk cheese.Referred to our clinic, the patient and his parents gave their informed consent to challenges.Fresh-food SPT were negative for cow's milk lactoalbumin, beef, and lamb, but positive (wheal diameter 5 mm) for fresh cow's milk casein and ewe's milk (wheal diameter 6 mm).Positive RAST for cow's milk casein (3.44 IU/ml) and elevated total IgE (195 IU/ml) were then found.During doubleblind, placebo-controlled, food-exercise challenge (DBPCFEC) with four planned doubling doses (5, 10, 20, 40 ml) of cow's milk masked in soybean formula, a reaction to cow's milk was con®rmed when symptoms developed with the 20-ml dose.At immunoblotting (following methods described elsewhere), however, serum IgE reacted strongly to ewe's and weakly to cow's milk proteins (Fig. 1).This patient, who had been allergic to ewe's milk since childhood, was observed to develop allergy to cow's milk at food-exercise challenge.Cow's milk and cow's milk products had been tolerated from birth until severe anaphylactic reactions were triggered by ingestion (with other foods) after exercise during adolescence.To the best of our knowledge, this is the second case of fooddependent, exercise-induced anaphylaxis diagnosed at DBPCFEC (6).Although ewe's milk allergy is usually coexistent with cow's milk allergy, it can also occur in isolation.The same phenomenon applies in the case of allergies to the milk of the goat, the mare, and other animals (7, 8).Common allergenic epitopes can be shared by ewe's and cow's milk protein; therefore, cow's milk allergy may be associated.Caseins are held responsible for this crossreaction, justifying caution regarding the should be useful for studying individuals at risk of infectious or autoimmune diseases associated with TNF-a promoter variants and increased TNF-a secretion.