Predicting outgrowth of IgE-mediated cow’s milk allergy: Diagnostic tests in children under two years of age
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Keywords
Cow’s milk allergy, Children, Skin prick test, Fresh milk, Specific immunoglobulin E, Outgrowth
Abstract
Background: Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow’s milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow’s milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old.
Methods: SPTs for CE and FM, tests for sIgEs (cow’s milk, casein, -lactoalbumin, - lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis.
Results: Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7 mm, 9 mm, and 10.5 kU/L, respectively; these values remained higher with ODPfo of 4 mm, 11 mm, and 10.5 kU/L at the last OFC.
Conclusion: Higher initial SPTs for FM and CE and higher initial sIgE levels for cow’s milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5 kU/L and initial SPT for fresh milk <9 mm are related to the acquisition of tolerance in the follow-up period.
References
2. Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: a systematic review. Ital J Pediatr. 2017;43:93.
3. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy. 2000;30:1540-6.
4. Saarinen KM, Suomalainen H, Savilahti E. Diagnostic value of skin-prick and patch tests and serum eosinophil cationic protein and cow’s milk-specific IgE in infants with cow’s milk allergy. Clin Exp Allergy. 2001;31:423-9.
5. Verstege A, Mehl A, Rolinck-Werninghaus C, Staden U, Nocon M, Beyer K, et al. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy. 2005;35:1220-6.
6. García-Ara MC, Boyano-Martínez MT, Díaz-Pena JM, MartínMunoz ˜ MF, Martín-Esteban M. Cow’s milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow’s milk allergy infants. Clin Exp Allergy. 2004;34:866-70.
7. Martorell A, García Ara MC, Plaza AM, Boné J, Nevot S, Echeverria L, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of the development of tolerance in cow’s milk allergy. Allergol Immunopathol (Madr). 2008;36:325-30.
8. Yavuz ST, Buyuktiryaki B, Sahiner UM, Birben E, Tuncer A, Yakarisik S, et al. Factors that predict the clinical reactivity and tolerance in children with cow’s milk allergy. Ann Allergy Asthma Immunol. 2013;110:284-9.
9. Vanto T, Helppilä S, Juntunen-Backman K, Kalimo K, Klemola T, Korpela R, et al. Prediction of the development of tolerance to milk in children with cow’s milk hypersensitivity. J Pediatr. 2004;144:218-22.
10. Wood RA, Sicherer SH, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013;131:805-12.
11. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS, et al. Adverse Reactions to Food Committee of American Academy of Allergy Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123 Suppl.:S365-83.
12. Rancé F, Juchet A, Brémont F, Dutau G. Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy. 1997;52:1031-5.
13. Calvani M, Alessandri C, Frediani T, Lucarelli S, Miceli Sopo S, Panetta V, et al. Correlation between skin prick test using commercial extract of cow’s milk protein and fresh milk and food challenges. Pediatr Allergy Immunol. 2007;18:583-8.
14. Zivanovic M, Atanaskovi´c-Markovi´c M, Medjo B, Gavrovi´cJankulovi´c M, Smiljani´c K, Tmuˇsi´c V, et al. Evaluation of food allergy in children by skin prick tests with commercial extracts and fresh foods, specific IgE and, open oral food challenge-our five years experience in food allergy work-up. Iran J Allergy Asthma Immunol. 2017;16:127-32.
15. Mehl A, Rolinck-Werninghaus C, Staden U, Verstege A, Wahn U, Beyer K, et al. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006;118:923-9.
16. Onesimo R, Monaco S, Greco M, Caffarelli, C, Calvani, M, Tripodi S, et al. Predictive value of MP4 (Milk Prick Four), a panel of skin prick test for the diagnosis of pediatric immediate cow’s milk allergy. Eur Ann Allergy Clin Immunol. 2013;45:201-8.
17. Calvani M, Berti I, Fiocchi A, Galli E, Giorgio V, Martelli A, et al. Oral food challenge: safety, adherence to guidelines and predictive value of skin prick testing. Pediatr Allergy Immunol. 2012;23:755-61.
18. Bellini F, Ricci G, Remondini D, Pession A. Cow’s milk allergy (CMA) in children: identification of allergologic tests predictive of food allergy. Eur Ann Allergy Clin Immunol. 2014;46:100-5.
19. Elizur A, Rajuan N, Goldberg MR, Leshno M, Cohen A, Katz Y. Natural course and risk factors for persistence of IgE-mediated cow’s milk allergy. J Pediatr. 2012;161:482-7.
20. Fiocchi A, Terracciano L, Bouygue GR, Veglia F, Sarratud T, Martelli A, et al. Incremental prognostic factors associated with cow’s milk allergy outcomes in infant and child referrals: the Milan Cow’s Milk Allergy Cohort study. Ann Allergy Asthma Immunol. 2008;101:166-73.
21. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cows’ milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy. 1993;23:124-31.
22. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. 1997;100: 444-51.
23. Santos A, Dias A, Pinheiro JA. Predictive factors for the persistence of cow’s milk allergy. Pediatr Allergy Immunol. 2010;21:1127-34.
24. Kido J, Hirata H, Ueno H, Nishi N, Mochinaga M, Ueno Y, et al. Evaluation of the skin-prick test for predicting the outgrowth of cow’s milk allergy. Allergy Rhinol (Providence). 2016;7: 139-43.
25. Neves FV, Beck CM, Gushken AK, Yonamine GH, Castro AP, Dorna MB, et al. Cow’s milk allergy: evaluating tolerance through skin prick test. Rev Assoc Med Bras (1992). 2016;62:537-43.
26. James JM, Sampson HA. Immunologic changes associated with the development of tolerance in children with cow milk allergy. J Pediatr. 1992;121:371-7.
27. Shek LP, Soderstrom L, Ahlstedt S, Beyer K, Sampson HA. Determination of food specific IgE levels over time can predict the development of tolerance in cow’s milk and hen’s egg allergy. J Allergy Clin Immunol. 2004;114:387-91.
28. Rottem M, Shostak D, Foldi S. The predictive value of specific immunoglobulin E on the outcome of milk allergy. Isr Med Assoc J. 2008;10:862-4.
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