Abstract
Background: cow’s milk allergy (CM) is among the most common food allergies in young children and is often outgrown by adulthood. Prior to developing a tolerance to CM, a majority of CM-allergic children may tolerate extensively-heated CM. This study aims to characterize the IgE- and T cell-reactivity to unheated CM and the progressively more heated CM-containing foods. Methods: CM-containing food extracts from muffin, baked cheese, custard and raw, pasteurized CM commercial extract were tested for skin prick test reactivity, IgE binding and T cell reactivity as assessed by IL-5 and IFNγ production. Results: the skin prick test (SPT) reactivity was significantly decreased to muffin extract compared to raw, pasteurized CM. Both IgE- and T-cell reactivity were readily detectable against food extracts from all forms of CM. Western blot analysis of IgE reactivity revealed variability between extracts that was protein-specific. T cell-reactivity was detected against all four extracts with no significant difference in IL-5 or IFNγ production between them. Conclusion: our data indicate that despite reduced clinical reactivity, extracts from heated CM-containing foods retain immunogenicity when tested in vitro, particularly at the T cell level.
Highlights
Cow’s milk (CM) allergy is one of the most common pediatric food allergies, affecting about 2% of young children in the United States [1,2], and its prevalence continues to increase [3]
Strong correlations were observed for CM versus casein-specific IgE and IgG4 titers
Further analysis of skin prick test data revealed that the largest SPT wheals were were seen with the raw, pasteurized CM extract, followed by extracts of baked cheese seen with the raw, pasteurized CM extract, followed by extracts of baked cheese, muffin and custard (Figure 1)
Summary
Cow’s milk (CM) allergy is one of the most common pediatric food allergies, affecting about 2% of young children in the United States [1,2], and its prevalence continues to increase [3]. Prior to the developing tolerance to unheated CM, one prospective study reported that 75% of CM-allergic children were able to tolerate extensively-heated (baked) CM [8]. Inclusion of baked forms of CM in the diet appears to accelerate the development of tolerance to unheated CM [9]. As a result, encouraging ingestion of heated forms of CM after documentation of tolerance (via OFC or report of regularly tolerating such items at home) has become common practice in the clinical management of CM allergy [10]
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