Cow's milk allergic children - Can component resolved diagnostics predict duration and severity?

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Abstract

Background: Cow's milk allergy (CMA) affects 2% of all children. This study investigatescomponent-resolved diagnostics(CRD) to cow's milk proteins in children suspected of CMA, by correlating the level of CRD with outcome of the oral challenge. Furthermore, we evaluate the ability of serial CRD measurements to distinguish children with persistent CMA from children developing tolerance. Methods: We included data from 78 children referred to the Allergy Centre during a 13-year period. Results from oral food challenges including threshold, severity, and sensitization data (IgE antibodies to whole milk protein, IgE components toward milk and skin prick test (SPT)) were collected. The milk allergic children were re-evaluated with sensitization data and rechallenges regularly. Results: Thirty-nine children had negative first challenges, and 39 had positive first challenges. The positive group was rechallenged and separated into 3 groups depending on time to remission. At inclusion, children with persistent CMA had significantly larger size of SPT and higher levels of s-IgE to milk and CRD compared to the other groups. SPT wheal size was significantly larger in children with persistent CMA compared to children outgrowing CMA. Furthermore, a correlation between s-IgE level to cow's milk and casein and the severity of the allergic reaction elicited by food challenges was found. Conclusion: Oral food challenge cannot be replaced by s-IgE to whole milk protein or milk components nor SPT in the diagnosis of CMA; however, high levels of milk components and s-IgE to milk increase the risk of a long-lasting or persisting CMA.

Original languageEnglish
JournalPediatric Allergy and Immunology
Volume29
Issue number2
Pages (from-to)194-199
ISSN0905-6157
DOIs
Publication statusPublished - Mar 2018

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Milk Hypersensitivity
Food
Hypersensitivity

Bibliographical note

© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Keywords

  • Animals
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Immune Tolerance/immunology
  • Immunoglobulin E/blood
  • Infant
  • Male
  • Milk Hypersensitivity/diagnosis
  • Milk Proteins/immunology
  • Milk/immunology
  • ROC Curve
  • Retrospective Studies
  • Skin Tests/methods

Cite this

@article{8a2551dc9df44899a623c8622850dc7d,
title = "Cow's milk allergic children - Can component resolved diagnostics predict duration and severity?",
abstract = "Background: Cow's milk allergy (CMA) affects 2{\%} of all children. This study investigatescomponent-resolved diagnostics(CRD) to cow's milk proteins in children suspected of CMA, by correlating the level of CRD with outcome of the oral challenge. Furthermore, we evaluate the ability of serial CRD measurements to distinguish children with persistent CMA from children developing tolerance. Methods: We included data from 78 children referred to the Allergy Centre during a 13-year period. Results from oral food challenges including threshold, severity, and sensitization data (IgE antibodies to whole milk protein, IgE components toward milk and skin prick test (SPT)) were collected. The milk allergic children were re-evaluated with sensitization data and rechallenges regularly. Results: Thirty-nine children had negative first challenges, and 39 had positive first challenges. The positive group was rechallenged and separated into 3 groups depending on time to remission. At inclusion, children with persistent CMA had significantly larger size of SPT and higher levels of s-IgE to milk and CRD compared to the other groups. SPT wheal size was significantly larger in children with persistent CMA compared to children outgrowing CMA. Furthermore, a correlation between s-IgE level to cow's milk and casein and the severity of the allergic reaction elicited by food challenges was found. Conclusion: Oral food challenge cannot be replaced by s-IgE to whole milk protein or milk components nor SPT in the diagnosis of CMA; however, high levels of milk components and s-IgE to milk increase the risk of a long-lasting or persisting CMA.",
keywords = "Animals, Child, Child, Preschool, Female, Humans, Immune Tolerance/immunology, Immunoglobulin E/blood, Infant, Male, Milk Hypersensitivity/diagnosis, Milk Proteins/immunology, Milk/immunology, ROC Curve, Retrospective Studies, Skin Tests/methods",
author = "Petersen, {Thomas Houmann} and Mortz, {Charlotte Gotthard} and Carsten Bindslev-Jensen and Esben Eller",
note = "{\circledC} 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.",
year = "2018",
month = "3",
doi = "10.1111/pai.12854",
language = "English",
volume = "29",
pages = "194--199",
journal = "Pediatric Allergy and Immunology",
issn = "0905-6157",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Cow's milk allergic children - Can component resolved diagnostics predict duration and severity?

AU - Petersen, Thomas Houmann

AU - Mortz, Charlotte Gotthard

AU - Bindslev-Jensen, Carsten

AU - Eller, Esben

N1 - © 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

PY - 2018/3

Y1 - 2018/3

N2 - Background: Cow's milk allergy (CMA) affects 2% of all children. This study investigatescomponent-resolved diagnostics(CRD) to cow's milk proteins in children suspected of CMA, by correlating the level of CRD with outcome of the oral challenge. Furthermore, we evaluate the ability of serial CRD measurements to distinguish children with persistent CMA from children developing tolerance. Methods: We included data from 78 children referred to the Allergy Centre during a 13-year period. Results from oral food challenges including threshold, severity, and sensitization data (IgE antibodies to whole milk protein, IgE components toward milk and skin prick test (SPT)) were collected. The milk allergic children were re-evaluated with sensitization data and rechallenges regularly. Results: Thirty-nine children had negative first challenges, and 39 had positive first challenges. The positive group was rechallenged and separated into 3 groups depending on time to remission. At inclusion, children with persistent CMA had significantly larger size of SPT and higher levels of s-IgE to milk and CRD compared to the other groups. SPT wheal size was significantly larger in children with persistent CMA compared to children outgrowing CMA. Furthermore, a correlation between s-IgE level to cow's milk and casein and the severity of the allergic reaction elicited by food challenges was found. Conclusion: Oral food challenge cannot be replaced by s-IgE to whole milk protein or milk components nor SPT in the diagnosis of CMA; however, high levels of milk components and s-IgE to milk increase the risk of a long-lasting or persisting CMA.

AB - Background: Cow's milk allergy (CMA) affects 2% of all children. This study investigatescomponent-resolved diagnostics(CRD) to cow's milk proteins in children suspected of CMA, by correlating the level of CRD with outcome of the oral challenge. Furthermore, we evaluate the ability of serial CRD measurements to distinguish children with persistent CMA from children developing tolerance. Methods: We included data from 78 children referred to the Allergy Centre during a 13-year period. Results from oral food challenges including threshold, severity, and sensitization data (IgE antibodies to whole milk protein, IgE components toward milk and skin prick test (SPT)) were collected. The milk allergic children were re-evaluated with sensitization data and rechallenges regularly. Results: Thirty-nine children had negative first challenges, and 39 had positive first challenges. The positive group was rechallenged and separated into 3 groups depending on time to remission. At inclusion, children with persistent CMA had significantly larger size of SPT and higher levels of s-IgE to milk and CRD compared to the other groups. SPT wheal size was significantly larger in children with persistent CMA compared to children outgrowing CMA. Furthermore, a correlation between s-IgE level to cow's milk and casein and the severity of the allergic reaction elicited by food challenges was found. Conclusion: Oral food challenge cannot be replaced by s-IgE to whole milk protein or milk components nor SPT in the diagnosis of CMA; however, high levels of milk components and s-IgE to milk increase the risk of a long-lasting or persisting CMA.

KW - Animals

KW - Child

KW - Child, Preschool

KW - Female

KW - Humans

KW - Immune Tolerance/immunology

KW - Immunoglobulin E/blood

KW - Infant

KW - Male

KW - Milk Hypersensitivity/diagnosis

KW - Milk Proteins/immunology

KW - Milk/immunology

KW - ROC Curve

KW - Retrospective Studies

KW - Skin Tests/methods

U2 - 10.1111/pai.12854

DO - 10.1111/pai.12854

M3 - Journal article

C2 - 29314279

VL - 29

SP - 194

EP - 199

JO - Pediatric Allergy and Immunology

JF - Pediatric Allergy and Immunology

SN - 0905-6157

IS - 2

ER -