Tang Chi-Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 89-112). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.vi / Table of contents --- p.viii / List of Tables --- p.xi / List of Figures --- p.xii / List of Abbreviations --- p.xiv / Chapter Chapter 1. --- General introduction --- p.1 / Chapter Chapter 2. --- Literature review --- p.4 / Chapter 2.1 --- History and prevalence of food allergy --- p.4 / Chapter 2.2 --- Mechanism and clinical symptoms of food allergy --- p.6 / Chapter 2.3 --- Tropomyosin as a major shellfish allergen --- p.13 / Chapter 2.4 --- Use of animal model in the studies of food allergy --- p.22 / Chapter 2.5 --- Future approaches for treatment of food allergy --- p.27 / Chapter Chapter 3. --- Cloning and expression of recombinant tropomyosin --- p.30 / Chapter 3.1 --- Introduction --- p.30 / Chapter 3.2 --- Materials and Methods --- p.31 / Chapter 3.2.1 --- Design of PCR primers for amplification of tropomyosin gene --- p.31 / Chapter 3.2.2 --- Cloning of PCR-amplified cDNA into vector --- p.32 / Chapter 3.2.3 --- Transformation of competent E. coli Ml5 cells --- p.34 / Chapter 3.2.4 --- Confirmation of DNA sequence of the cloned vector --- p.34 / Chapter 3.2.5 --- Induction of the recombinant protein --- p.35 / Chapter 3.2.6 --- Purification and storage of the recombinant protein under native condition --- p.36 / Chapter 3.2.7 --- Concentration measurement and storage of the recombinant protein --- p.37 / Chapter 3.2.8 --- Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.38 / Chapter 3.2.9 --- Regeneration of the Ni-NTA column --- p.40 / Chapter 3.3 --- Results and discussion --- p.42 / Chapter 3.3.1 --- DNA sequence of the cloned vector --- p.42 / Chapter 3.3.2 --- Expression of the recombinant protein --- p.42 / Chapter 3.3.3 --- Sodium dodecyl sulfate polyacrylamide gel eletrophoresis (SDS-PAGE) --- p.43 / Chapter Chapter 4. --- Induction of hypersensitive response to shrimp tropomyosin in mice --- p.47 / Chapter 4.1 --- Introduction --- p.47 / Chapter 4.2 --- Materials and methods --- p.52 / Chapter 4.2.1 --- Mice and reagents --- p.52 / Chapter 4.2.2 --- Animal sensitization and challenge --- p.53 / Chapter 4.2.3 --- Morphological and behavioral changes --- p.54 / Chapter 4.2.4 --- Tropomyosin-specific IgE level --- p.55 / Chapter 4.2.5 --- Passive cutaneous anaphylaxis (PCA) reaction --- p.56 / Chapter 4.2.6 --- Tropomyosin-specific cellular proliferation level of splenocytes --- p.56 / Chapter 4.2.7 --- Cytokine profiles of splenoctyes --- p.58 / Chapter 4.2.8 --- Histological examination of small intestine --- p.59 / Chapter 4.2.9 --- Statistical analysis --- p.59 / Chapter 4.3 --- Results --- p.63 / Chapter 4.3.1 --- Morphological and behavioral changes after challenge --- p.63 / Chapter 4.3.2 --- Tropomyosin-specific IgE level --- p.63 / Chapter 4.3.3 --- Passive cutaneous anaphylaxis (PCA) --- p.64 / Chapter 4.3.4 --- Tropomyosin-specific cellular proliferation level of splenocytes --- p.68 / Chapter 4.3.5 --- Cytokine profiles of splenocytes --- p.70 / Chapter 4.3.6 --- Histology of small intestines --- p.76 / Chapter 4.4 --- Discussion --- p.79 / Chapter Chapter 5. --- General conclusion --- p.88 / References --- p.89

Yang, Fan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 111-132). / Abstracts in English and Chinese. / ACKNOWLEDGEMENTS --- p.iii / ABSTRACT --- p.iv / TABLE OF CONTENTS --- p.viii / LIST OF FIGURES --- p.xii / LIST OF TABLES --- p.xv / LIST OF ABBREVIATIONS --- p.xvi / Chapter Chatper 1. --- General Introduction --- p.1 / Chapter Chapter 2. --- Literature Review --- p.5 / Chapter 2.1 --- Facts on food allergy --- p.5 / Chapter 2.1.1 --- Food allergy and its prevalence --- p.5 / Chapter 2.1.2 --- Pathogenesis of food allergy --- p.6 / Chapter 2.1.3 --- Clineal disorders caused and diagnosis of food allergy --- p.8 / Chapter 2.2 --- Allergenicity assessment of genetically engineered food --- p.13 / Chapter 2.2.1 --- The structural and sequence homology of proteins as a criterion for food allergenicity assessment --- p.14 / Chapter 2.2.2 --- Digestion stability as a criterion for food allergenicity assessment --- p.15 / Chapter 2.2.3 --- Animal models for Food Allergenicity Assessment --- p.21 / Chapter 2.3 --- The importance of rice and its nutritional facts --- p.27 / Chapter 2.3.1 --- The importance of rice --- p.27 / Chapter 2.3.2 --- Rice nutritional facts and its relationship with malnutrition --- p.28 / Chapter 2.4 --- Food allergenicity research in rice --- p.30 / Chapter 2.5 --- Glutelin overexpression transgenic rice GT3 --- p.33 / Chapter 2.6 --- Recent and future perspectives for treatment of food allergy --- p.36 / Chapter Chapter 3. --- Materials and Methods --- p.39 / Chapter 3.1 --- Rice Seed Protein Extraction --- p.39 / Chapter 3.1.1 --- Rice varieties for protein extraction --- p.39 / Chapter 3.1.2 --- Protein extraction from rice seeds --- p.39 / Chapter 3.1.3 --- Fractionation of major rice seed storage proteins --- p.40 / Chapter 3.1.4. --- Protein quantification --- p.41 / Chapter 3.1.5 --- Tricine SDS-PAGE --- p.42 / Chapter 3.2 --- Simulated Gastric Digestibility Assay --- p.43 / Chapter 3.2.1 --- Assay System --- p.43 / Chapter 3.2.2 --- Preparation of Simulated Gastric Fluid --- p.43 / Chapter 3.2.3 --- Assay Procedures --- p.44 / Chapter 3.2.4 --- Results Interpretation --- p.44 / Chapter 3.3 --- Construction of Mouse Models --- p.45 / Chapter 3.3.1 --- Mouse strain and reagents used --- p.45 / Chapter 3.3.2 --- Mouse Model I --- p.46 / Chapter 3.3.3 --- Mouse Model II --- p.50 / Chapter 3.3.4 --- Mouse Model III --- p.51 / Chapter 3.4 --- Bioinformatic Analysis of Glutelin Sequence --- p.52 / Chapter 3.5 --- Epitope Mapping of Glutelin --- p.55 / Chapter 3.5.1 --- Bioinformatic Analysis --- p.55 / Chapter 3.5.2 --- Direct and Competitive ELISA --- p.56 / Chapter 3.5.3 --- Western Blot Analysis --- p.57 / Chapter 3.5.4 --- IgE-binding assay --- p.58 / Chapter Chapter 4. --- Results and Discussion --- p.60 / Chapter 4.1 --- Rice Seed Protein Extraction --- p.60 / Chapter 4.1.1 --- Rice Protein Extraction --- p.60 / Chapter 4.1.2 --- Extraction of rice major seed storage protein fractions --- p.62 / Chapter 4.2 --- Simulated Gastric Digestibility Assay --- p.64 / Chapter 4.2.1 --- Pepsin Digestibility of total protein from GT3 and WT rice seeds --- p.64 / Chapter 4.2.2 --- Pepsin Digestibility of major storage protein fractions in GT3 and WT rice --- p.68 / Chapter 4.2.3 --- Summary of Pepsin Digestibility Assay --- p.74 / Chapter 4.3 --- Mouse Model I --- p.75 / Chapter 4.3.1 --- Protein-specific IgE levels --- p.75 / Chapter 4.3.2 --- Protein-specific IgG1 and IgG2a levels --- p.77 / Chapter 4.3.3 --- Allergic Response Test --- p.79 / Chapter 4.3.4 --- Summary from Mouse Model I --- p.81 / Chapter 4.4 --- Mouse Model II --- p.83 / Chapter 4.4.1 --- Proteins specific IgE levels --- p.84 / Chapter 4.4.2 --- Proteins specific IgG1 and IgG2a levels --- p.85 / Chapter 4.4.3 --- Allergic Response Test --- p.87 / Chapter 4.4.4 --- Summary from Mouse Model II --- p.88 / Chapter 4.5 --- Mouse Model III --- p.90 / Chapter 4.5.1 --- Protein-specific IgE levels --- p.90 / Chapter 4.5.2 --- Proteins specific IgG1 and IgG2a levels --- p.91 / Chapter 4.5.3 --- Allergic Response Test --- p.93 / Chapter 4.5.4 --- Summary from Mouse Model III --- p.93 / Chapter 4.6 --- Potential allergenicity of rice glutelin by bioinformatics and epitope mapping --- p.94 / Chapter 4.6.1 --- Bioinformatic analysis --- p.94 / Chapter 4.6.2 --- ELISA analysis of synthesized epitopes --- p.97 / Chapter 4.6.3 --- Western Blot Analysis --- p.99 / Chapter 4.6.4 --- IgE-binding assay --- p.103 / Chapter Chapter 5. --- Conclusion and Future Perspectives --- p.109 / References --- p.111

Lee, Yuen Shan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 81-102). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.iv / Table of contents --- p.vi / List of Figures --- p.ix / List of Abbreviations --- p.xi / Chapter Chapter 1. --- General introduction --- p.1 / Chapter Chapter 2. --- Literature review / Chapter 2.1 --- History of food allergy research --- p.3 / Chapter 2.2 --- Prevalence of food allergy --- p.4 / Chapter 2.3 --- Clinical symptoms of food allergy --- p.6 / Chapter 2.4 --- Mechanism of food allergy --- p.6 / Chapter 2.4.1 --- Properties of food allergens --- p.7 / Chapter 2.4.2 --- Exposures to food allergens in the gastrointestinal tract --- p.8 / Chapter 2.4.3 --- Oral tolerance and its relationship to food allergy --- p.9 / Chapter 2.4.4 --- Cellular mechanism of food allergy --- p.13 / Chapter 2.5 --- Studies on seafood allergies and allergens --- p.17 / Chapter 2.6 --- Use of animal models in the study of food allergy --- p.22 / Chapter 2.6.1 --- Selection of species and strain for developing animal models --- p.22 / Chapter 2.6.2 --- Parameters of sensitization protocol --- p.25 / Chapter 2.6.3 --- Lessons from animal models --- p.27 / Chapter 2.6.3.1 --- Investigations on pathogenesis of food allergy --- p.27 / Chapter 2.6.3.2 --- Studies on development of therapeutic strategies --- p.28 / Chapter Chapter 3. --- Characterization of hypersensitive responses to recombinant shrimp tropomyosin in mice / Chapter 3.1 --- Introduction --- p.30 / Chapter 3.2 --- Materials and Methods / Chapter 3.2.1 --- Preparation of the recombinant shrimp tropomyosin / Chapter 3.2.1.1 --- Expression of the recombinant shrimp tropomyosin --- p.32 / Chapter 3.2.1.2 --- Extraction and purification of the recombinant protein under native condition --- p.32 / Chapter 3.2.1.3 --- Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.33 / Chapter 3.2.1.4 --- Quantification of the recombinant protein and detection of level of endotoxin in the protein --- p.34 / Chapter 3.2.2 --- Characterization of hypersensitive responsesin mice / Chapter 3.2.2.1 --- Mice --- p.37 / Chapter 3.2.2.2 --- Sensitization and challenge of mice --- p.37 / Chapter 3.2.2.3 --- Assessment of systemic anaphylaxis responses --- p.38 / Chapter 3.2.2.4 --- Detection of shrimp tropomyosin specific IgE level --- p.39 / Chapter 3.2.2.5 --- Passive cutaneous anaphylaxis (PCA) test --- p.40 / Chapter 3.2.2.6 --- In vitro proliferation assay under stimulation of shrimp tropomyosin --- p.40 / Chapter 3.2.2.7 --- Cytokine profile of splenocytes --- p.42 / Chapter 3.2.2.8 --- Histological examination of small intestine --- p.44 / Chapter 3.2.2.9 --- Statistical analysis --- p.45 / Chapter 3.3 --- Results / Chapter 3.3.1 --- Preparation of the recombinant shrimp tropomyosin --- p.47 / Chapter 3.3.2 --- Induction of systemic anaphylaxis responses after challenge --- p.48 / Chapter 3.3.3 --- Elevated level of shrimp tropomyosin specific IgE --- p.49 / Chapter 3.3.4 --- Passive cutaneous anaphylaxis (PCA) reactions --- p.50 / Chapter 3.3.5 --- Proliferation response of splenocytes under in vitro stimulation --- p.54 / Chapter 3.3.6 --- Cytokine profiles of restimulated splenocytes --- p.58 / Chapter 3.3.7 --- Histology of small intestine --- p.65 / Chapter 3.4 --- Discussion --- p.68 / Chapter Chapter 4. --- General conclusion --- p.78 / References --- p.81

O Teste de Provocação Oral Duplo Cego Placebo Controlado (TPODCPC) é considerado um método diagnóstico de extrema importância na alergia alimentar, entretanto não existe, em nosso meio, uma padronização em relação aos materiais e métodos para a sua execução, especialmente na faixa etária pediátrica. O objetivo deste estudo foi adaptar TPODCPC para o diagnóstico de alergia às proteínas do leite de vaca (APLV) mediada por IgE, em crianças e adolescentes. O objetivo secundário foi descrever a relação entre os antecedentes de atopia associados a dados laboratoriais e os resultados dos TPODCPC. Foram incluídos 58 pacientes que se dividiram em dois grupos. O grupo 1 foi composto por 39 pacientes (mediana de idade: 5,3 anos; 1,6M:1F) com história sugestiva de APLV IgE mediada, sem relato de história de anafilaxia recente e com pesquisa positiva de IgE específica para leite de vaca (LV) e/ou frações. No grupo 2 foram incluídos 19 pacientes (mediana de idade: 8,3 anos; 1,4 M:1F) sem história sugestiva de APLV. Os itens avaliados na adaptação deste método diagnóstico incluíram: escolha do local, materiais a serem utilizados e operacionalização do teste. O hospital dia mostrou-se, por suas características, adequado à realização do exame. Em relação aos materiais escolhidos para a oferta do veículo, os recipientes opacos e vedados revelaram-se mais adaptados às necessidades do teste, os veículos de maior aceitação foram sopa de legumes e bebida à base de soja e o LV a ser oferecido de maneira mais apropriada foi na forma líquida e com baixo teor de lactose. As dificuldades observadas na realização do TPODCPC não comprometeram a sua execução, entretanto houve dificuldade na interpretação dos resultados especialmente nos pacientes com sintomas como pápulas periorais ou achados clínicos inespecíficos. Observou-se concordância entre os critérios clínico-laboratoriais adotados para a definição dos grupos 1 e 2 com os resultados do TPODCPC. Em conclusão, o teste mostrou-se exeqüível e seguro e a adaptação deste para o diagnóstico de APLV IgE mediada nesta faixa etária pediátrica foi possível, sendo necessária a avaliação da sua reprodutibilidade em outras populações. / The Double Blind Placebo Controlled Food Challenge (DBPCFC) is considered an important method for food allergy diagnosis, nevertheless it is not standardized among us. The aim of this study was to adapt DBPCFC for cows milk allergy (CMA) diagnosis in children and adolescents. A secondary aim was to describe the relation between history of atopy and laboratorial findings with DBPCFC results. It was included 58 patients that were distributed in two groups. Group 1 was composed of 39 patients (median age: 5,3 years; 1,6M:1F) with suggestive history of CMA without recent anaphylaxis, and specific IgE to cow´s milk (CM) and/or its fractions. In group 2 was included 19 patients (median age 8,3 years; 1,4 M:1F) where the CMA diagnosis was excluded based on clinical findings. The items evaluated in the adaptation of this method were: setting choice, kind of milk processing and vehicles, besides material and test performance. Day hospital was considered adequate for this test. Regarding to elected materials to offer the vehicle, opaque and sealed recipients showed more suitable to test demands. Vehicles more accepted were legumes soup and soy beverage and the most adequate CM to be offered was liquid and with low lactose concentration. The difficult observed in performance of DBPCFC do not compromise its execution, however the interpretation of the results was very difficult specially in patients with perioral wheals and unspecific clinical findings. There is an agreement Comparing adopted clinical and laboratorial criterion for definition of group 1 and 2 with DBPCFC results. In conclusion, the test proved to be feasible and safe and its adaptation is possible for IgE mediated CMA diagnosis, being necessary to evaluate its reproducibility in other populations.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

Introdução: A doença do refluxo gastroesofágico (DRGE) refratária pode estar relacionada à maior sensibilização a alimentos pelo dano ácido-péptico às junções intercelulares e/ou pelo aumento do pH gástrico pelos inibidores de bomba de prótons (IBPs). A falha na resposta ao tratamento da DRGE tem sido atribuída, entre outras causas, à esofagite eosinofílica (EE). Objetivo: O objetivo principal do estudo foi avaliar a sensibilização a alimentos nos pacientes com DRGE refratária. Como objetivos secundários, comparamos as características dos pacientes sensibilizados com os não sensibilizados e verificamos a resposta clínica da DRGE à dieta de restrição aos alimentos aos quais o paciente estava sensibilizado. Métodos: Os pacientes com DRGE refratária realizaram dieta de restrição baseada no resultado de teste cutâneo de leitura imediata (TCLI) e teste cutâneo de contato (TCC) com alimentos. As características dos pacientes sensibilizados foram comparadas com os não sensibilizados com relação à atopia e número de eosinófilos na mucosa esofágica. Resultados: A prevalência de sensibilização a alimentos nos pacientes com DRGE refratária foi de 27,7%, sendo 15,3% pelo TCLI e 12,3% pelo TCC. Os asmáticos apresentaram maior sensibilização a alimentos (p=0,008). Foi identificada a presença de eosinófilos na mucosa esofágica em 15,8% dos pacientes e esta correlacionou-se com maior sensibilização a alimentos (p=0,011). Foi confirmado um caso de EE. A dieta de exclusão aos alimentos identificados promoveu melhora clínica dos sintomas da DRGE (p=0,004). Conclusão: A presença de eosinófilos na mucosa esofágica associada à maior sensibilização a alimentos e a resposta à dieta de exclusão em pacientes com testes positivos sugere que a DRGE refratária pode representar um estágio inicial da EE. / Abstract: Refractory gastroesophageal reflux disease (GERD) can be related to greater sensitization to foods due to peptic acid damage to intercellular junctions and/or due to the increase in gastric pH by proton pump inhibitors (PPIs). The lack of response to treatment of GERD has been attributed to, among other causes, eosinophilic esophagitis (EE). Objective: The principal objective of the study was to evaluate the sensitization to foods in patients with refractory GERD. As secondary objectives, we compared the characteristics of sensitized patients with those non-sensitized and found a clinical response of GERD to a diet restricting foods to which the patient was sensitized. Methods: Patients with refractory GERD were put on a restriction diet based on the results of skin prick test (SPT) and atopy patch test (APT) with foods. The characteristics of the sensitized patients were compared to those non-sensitized in relation to atopia and number of eosinophils in the esophageal mucosa. Results: The prevalence of sensitization to foods in patients with refractory GERD was 27.7%, where 15.3% were determined by SPT and 12.3% by APT. Asthmatics showed higher sensitization to foods (p=0.008). The presence of eosinophils in the esophageal mucosa was determined in 15.8% of patients, and this correlated with greater sensitization to foods (p=0.011). One case of EE was confirmed. A diet excluding identified sensitizing foods led to clinical improvement with regard to GERD symptoms (p=0,004). Conclusion: The presence of eosinophils in esophageal mucosa associated with greater sensitization to foods and the response to restriction diet in patients with positive tests suggest that refractory GERD can represent an initial stage of EE.

In this research, beta-lactoglobulin was chemically modified by attaching different levels of stearic acid to the protein. The effect of this modification on hydrophobic!ty, emulsifying and foam properties, digestibility and allergenicity of the protein was investigated. It was found that the effect of fatty acid attachment or lipophilization depended on the amount of fatty acids attached to the protein. Incorporation of the hydrophobic ligands led to increased hydrophobic interactions, resulting in a decreasing solubility with extent of incorporation. Furthermore, the surface hydrophobicity measurements showed that the two fluorescence probes 8-anilinonaphthalene-l-sulfonate (ANS) and cis-parinaric acid (CPA) used for the surface hydrophobicity measurements were not equivalent This may support the. observation by earlier workers that ANS measures aromatic hydrophobicity and CPA aliphatic hydrophobicity. The studies on surface functional properties i.e. emulsifying and foaming properties, indicated that there was some improvement in these functional properties at low and medium levels of incorporation which decreased as the extent of fatty acid attachment further increased. The improvement, of these functional properties could be attributed to improved amphiphilicity of the proteins at these levels of incorporation. This research also showed that both high solubility and high ANS surface hydrophobicity is needed for the best emulsifying properties. In vitro digestibility studies showed a decrease in digestibility of the modified proteins with increased lipophilization. From the passive cutaneous anaphylaxis experiments, it was found that the level of fatty acid attachment to the protein had a significant effect on its ability to elicit IgE antibodies. Increased ability to elicit IgE antibodies was observed at a low level of fatty acid. When a medium level of fatty acid was attached the ability to elicit antibodies was reduced and almost completely destroyed when a higher level of fatty acid was incorporated. The above observations could be explained by the fact that the low level incorporation of fatty acid led to changes in the protein structure which exposed more allergenic sites. The almost complete destruction of the allergenicity could be attributed to denaturation of the protein which reduced or destroyed available allergenic sites. The antigenicity or binding of the modified proteins to the IgG antibodies raised against the native protein was studied by both direct and competitive enzyme linked immunosorbent assay. It was found that at low and medium levels of incorporation, the proteins demonstrated increased binding ability compared to the native protein. This was attributed to the increased exposure of antigenic sites on the protein with fatty acid incorporation. However, the protein with high level of incorporated fatty acid showed decreased binding ability. / Land and Food Systems, Faculty of / Graduate

Introdução: Estudos demonstram que as alergias alimentares influenciam negativamente a qualidade de vida dos pacientes e familiares. Embora este tema seja importante, ainda há poucos estudos na literatura internacional e não existe estudos nacionais qualitativos em alergia alimentar. Objetivos: Compreender as percepções de familiares de crianças e adolescentes com alergia às proteínas do leite de vaca em relação à doença e seu tratamento. Trajetória Metodológica: Trata-se de um estudo qualitativo, em que foram entrevistados os familiares diretamente responsáveis pelos cuidados de crianças e adolescentes com alergia à proteína do leite de vaca confirmada, acompanhados no ambulatório de alergia alimentar da Unidade de Alergia e Imunologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo há, pelo menos, um ano. As entrevistas foram realizadas em condições de privacidade e foram propostas duas questões: \"Fale sobre a sua experiência com o tratamento da alergia à proteína do leite de vaca\" e \"O que o(a) Sr(a) espera do tratamento da doença do seu(sua) filho(a)?\". Os dados foram gravados, transcritos, avaliados utilizando-se o método de análise de conteúdo, sendo constituídas categorias e subcategorias a partir dos discursos. Resultados: Foram realizadas nove entrevistas, a maioria com mães dos pacientes. Surgiram três categorias com subcategorias: A. Tratamento e educação do paciente e familiares (experiências vividas, base do tratamento e como lidar com a doença), B. Resolução da doença (expectativa e melhora gradativa), C. Qualidade de vida (inclusão social, cotidiano familiar e custo dos alimentos). Os familiares vivenciaram dificuldades durante o início do tratamento, mas revelaram que as orientações fornecidas no seguimento tornaram as adaptações à doença mais fáceis. Eles também compararam a alergia à proteína do leite de vaca com outras doenças crônicas e destacaram a importância do acompanhamento de seus filhos na instituição para realizar um controle adequado. Além disso, enfatizaram que o seguimento também é importante para os profissionais de saúde, que aprimoram os conhecimentos sobre a doença. Os familiares comentaram sobre as dificuldades em obter a colaboração de outros membros da família em relação à dieta de exclusão, suas experiências frente a uma reação alérgica, dúvidas quanto ao tratamento e lacunas do conhecimento sobre a doença entre outros médicos e na população em geral. Alguns deles acreditavam que não havia tratamento para a alergia à proteína do leite de vaca, porque não existiam medicamentos ou vacinas, mas mantinham a esperança da descoberta de uma cura. A maioria dos familiares estava satisfeita com a melhora gradativa dos seus filhos, a qual era percebida pela redução da gravidade dos sintomas e tolerância a traços de leite. Além disso, eles comentaram sobre os esforços em proporcionar uma vida normal para seus filhos, as mudanças em suas vidas e a dificuldade em comprar alimentos especiais. Conclusão: O estudo qualitativo permitiu entender como os familiares enfrentam a doença, suas histórias e as expectativas quanto ao tratamento. Os familiares de crianças e adolescentes com alergia à proteína do leite de vaca sentem um grande impacto da doença e necessitam de apoio e orientação dos profissionais de saúde / Introduction: Some studies have shown that food allergies negatively influence on patient\'s and caregivers\' quality of life. Although this theme is important, there aren\'t many studies in the international literature and there is no national qualitative study in food allergy. Objectives: To understand the perceptions of caregivers of patients with cow\'s milk allergy regarding the disease and its treatment. Methods: Qualitative study in which caregivers of children and adolescents with confirmed cow\'s milk allergy followed, at least, for one year, were interviewed. They were recruited from the outpatient clinic of the Allergy and Immunology Division from Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The interviews were conducted under conditions of privacy and two opened questions were proposed: \"Tell me about your experience with cow\'s milk allergy treatment\" and \"What do you expect from your child\'s disease treatment?\". Data were audio-recorded, transcribed, analyzed using the content analysis method and categories and subcategories were generated based on their speeches. Results: Nine interviews were done, mostly with mothers of the patients. Three categories with subcategories emerged: A. Treatment and education of the patient and their caregivers (life experiences, bases of treatment, coping with the disease), B. Resolution of the disease (hope, gradual improvement), C. Quality of life (social inclusion, family daily activities, costs of dietary treatment). Caregivers experienced difficulties during the initial treatment but pointed out that the guidance given during follow-up made the adjustments easier. They also compared the cow\'s milk allergy with other chronic diseases and highlighted the importance of their children follow-up in this institution for adequate control of them. Moreover, they emphasized that the follow-up is also important for medical staff, for knowledge improvement about the disease. Family members commented on the difficulties about lack of cooperation from other family members regarding the restrictive diet, their experience coping with the allergic reaction, doubts about the treatment and gaps on knowledge about the disease by other physicians and people. Some of them believed that there is no treatment for the disease, because there are no drugs or vaccines, but they were waiting for cure. The majority of relatives were satisfied with the gradual improvement of patients observed by reduction on the severity of symptoms and tolerance of milk traces within foods. In addition, they commented on the efforts to give a normal life for their children, the changes in their daily lives and the difficulty to buy special products. Conclusion: This qualitative study allowed us to understand how families cope with the disease, their histories and expectations about the treatment. The relatives of children and adolescents with cow\'s milk allergy feel a great burden of the disease and need support and orientation from health professionals

As proteínas do leite de vaca são os principais alérgenos relacionados à alergia alimentar em crianças e o diagnóstico inclui a realização do teste de provocação oral duplo cego placebo controlado (TPODCPC). Apesar da acurácia, este teste envolve riscos, necessita condições especiais para sua realização e apresenta limitações em crianças de baixa idade e em pacientes anafiláticos. Assim, há necessidade de métodos diagnósticos alternativos, entre eles o estabelecimento de pontos de corte de concentrações de IgE sérica específica para leite de vaca, que permitam o diagnóstico mesmo sem a realização do TPODCPC. O objetivo deste estudo foi estabelecer uma concentração discriminante de IgE sérica específica para leite de vaca e suas frações protéicas para o diagnóstico de alergia à proteína do leite de vaca (APLV) e avaliar se há diferentes concentrações discriminantes de IgE específica para este alérgeno no grupo de pacientes com anafilaxia. Realizou-se um estudo de coorte histórica incluindo pacientes com APLV e grupo controle composto por pacientes com suspeita não confirmada de APLV. Para estes objetivos, foram construídas curvas ROC para os seguintes alérgenos: leite de vaca, caseína, a- lactoalbumina e b-lactoglobulina. Os níveis de IgE específica foram avaliados posteriormente, em separado, nos pacientes com anafilaxia. Foram incluídos 123 pacientes (1,3M:1F mediana = 1,91 anos, com idade de 3,5 meses a 13,21 anos) com diagnóstico confirmado de APLV através de TPODCPC (n=26), presença de anafilaxia à proteína do leite de vaca (n=46) ou história clínica fortemente sugestiva de APLV associada à pesquisa positiva de IgE específica através de teste cutâneo (n=51). Entre os 65 pacientes com anafilaxia, 19 confirmaram o diagnóstico posteriormente, através de testes de provocação. O grupo controle foi composto por 61 pacientes (1M:1,1F) com idade variando entre 0,66 e 16,7 anos (mediana= 6,83 anos). A metodologia adotada para estabelecimento dos pontos de corte foi a construção de curva ROC e posterior cálculo dos valores preditivos positivos e negativos. Os pontos de corte obtidos considerando-se uma especificidade de 98% e um valor preditivo positivo acima de 95% foram: 3,06 kU/L para o leite de vaca, 2,06 kU/L para a- lactoalbumina, 1,85 kU/L para b-lactoglobulina e 1,47 kU/L para caseína. O valor de IgE específica para leite de vaca revelou-se com maior capacidade discriminante que os encontrados para as frações, tornando estes últimos dispensáveis. Com relação à anafilaxia, a curva ROC construída a partir de uma análise comparativa entre pacientes com e sem esta manifestação, indicou um ponto de corte elevado de 39kU/L, tornando impossível sua utilização na prática clínica. O presente estudo mostrou que um ponto de corte de IgE específica para leite de vaca é suficiente para o diagnóstico de APLV, não sendo necessária a avaliação das frações protéicas. Na presença de anafilaxia desencadeada pelo leite de vaca não há necessidade da utilização de pontos de corte de IgE específica, sendo os dados clínicos e a sensibilização ao leite suficientes para o diagnóstico de APLV. / Cow\'s milk proteins are the main allergens related to food allergy in children and the diagnosis include the double blind placebo controlled food challenge (DBPCFC). Although this test presents accuracy, it involves risks, it is necessary special conditions and it presents limitations in infants and anaphylactic patients. It is necessary other diagnostic methods, among them the cut off values for IgE specific for milk to allow the cow\'s milk allergy (CMA) diagnosis without the need to perform the DBPCFC. The objective of this study was to establish a discriminating concentration of specific IgE to cow\'s milk and its proteins fractions for the diagnosis of allergy to CMA and to assess if there are different discriminating concentrations of specific IgE to this allergen in the group of patients with anaphylaxis. It was carried out a historical cohort study including patients with CMA and the control group was composed by patients with excluded CMA suspicion. To obtain the cutoff points for diagnosis of CMA , ROC curves were constructed for the following allergens: cow\'s milk, casein, a-lactalbumin and a b-lactoglobulin. The levels of specific IgE were later evaluated, separately, in patients with anaphylaxis. The study included 123 patients (1.3 M: 1F median = 1.91 years, ranging from 3.5 months to 13.21 years) with confirmed diagnosis of CMPA through DBPCFC (n = 26), the presence of anaphylaxis triggered by cow\'s milk protein (n = 46) or strongly suggestive clinical history associated with positive specific IgE through skin test (n = 51). Among the 65 patients with anaphylaxis, 19 confirmed the diagnosis through challenge tests . The control group was consisted of 61 patients (1M: 1.1 F) with ages ranging between 0.66 and 16.7 years (mean 6.86, median = 6.83 years). The methodology to stablish the cutoff was the construction of a ROC curve and subsequent calculation of positive and negative predictive value. The cutoff points obtained considering a 98% specificity and positive predictive value above 95% were: 3.06 kU / L for cow\'s milk, 2.06 kU/ L for/ a-lactalbumin, 1.85 kU/ L for/ b-lactoglobulin and 1.47 kU / L for casein. The value of specific IgE to cow\'s milk showed better discriminant capacity than those found for the fractions, being these last values dispensable. In relation to anaphylaxis, the ROC curve constructed from a comparative analysis between patients with and without this manifestation indicated a very high cutoff of 39kU/L, being without value for the clinical practice. This study showed that the cut off point detected for hole cows milk was enough for CMA diagnosis, without necessity of the milk fractions evaluation. In the presence of cows milk anaphylaxis, it is not necessary the IgE specific cut off value, being the clinical data and the sensitization to cows milk enough for the CMA diagnosis.