Abstract
Cow’s milk allergy (CMA) belongs to one of the most common food allergies in early childhood affecting 2–3% of children under 3 years of age. However, approximately 1% of adults remain allergic to cow’s milk, often showing severe reactions even to traces of milk. In our study, we recruited patients with different clinical manifestations of CMA, including patients with anaphylaxis and less severe symptoms. We assessed the sensitization patterns and allergic responses of these subgroups through different immunological and cell-based methods. Sera of patients were investigated for IgE against whole cow’s milk and its single allergens by CAP- FEIA. In a newly developed in-house multiplex dot assay and a basophil activation test (BAT), cow’s milk allergens, in addition to human breast milk and single allergens from cow’s and human milk were analyzed for IgE recognition and severity of CMA in the included patients. Both the CAP-FEIA routine diagnostic and the multiplex dot test could differentiate CMA with severe from milder allergic reactions by means of the patients’ casein sensitization. The BAT, which mirrors the clinical response in vitro, confirmed that basophils from patients with severe reactions were more reactive to caseins in contrast to the basophils from more moderate CMA patients. By means of this improved component-resolved diagnosis of CMA, individual sensitization patterns could be assessed, also taking sensitization against human milk into consideration.
Highlights
IgE-mediated cow’s milk allergy (CMA) is a common food allergy affecting 2–3% of young children under 3 years of age, involving the skin, the gastrointestinal tract, the respiratory tract or the cardio-vascular system
Looking for prognostic markers, low casein and ß-lactoglobulin-specific IgE-antibody concentrations were found to be predictive for the resolution of CMA [5], and whole cow’s milk specific IgE above 50 kUA /L were associated with persistent CMA when studying a population of children with CMA, in terms of the prognosis for developing tolerance [6]
We present comprehensive data of different diagnostic tests to characterize sensitization patterns of patients with different clinical pictures of CMA
Summary
IgE-mediated cow’s milk allergy (CMA) is a common food allergy affecting 2–3% of young children under 3 years of age, involving the skin, the gastrointestinal tract, the respiratory tract or the cardio-vascular system. A high proportion of young children, approximately 85%, develop a natural tolerance. Cow’s milk consists of caseins accounting for approximately 80% and whey proteins accounting for approximately 20% of the total protein content. Looking for prognostic markers, low casein and ß-lactoglobulin-specific IgE-antibody concentrations were found to be predictive for the resolution of CMA [5], and whole cow’s milk specific IgE above 50 kUA /L were associated with persistent CMA when studying a population of children with CMA, in terms of the prognosis for developing tolerance [6]. Ito et al [8] and D’Urbano et al [9] confirmed these data
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