Predictive Factors for Oral Immune Modulation in Cow Milk Allergy.

Ioana Adriana Muntean,Carmen Teodora Dobrican,Lena Katharina Wiest,Diana Deleanu,Emanuela Duca,Irena Pintea,Ioana Corina Bocsan,Anca Dana Buzoianu,Corina Ureche

doi:10.3390/nu14030494

Abstract

Aim: The present study analyzed clinical and biological factors that might predict achievement of tolerance in patients with IgE-mediated cow milk allergy (CMA). Method: Seventy patients with IgE-mediated CMA (44.24 ± 24.16 months) were included in the study. The patients were evaluated clinically through skin prick test and sIgE to whole milk, casein, beta-lactoglobulin and alpha-lactalbumin. An eviction diet of 6 months was established, followed by oral food challenge test (OFC) and oral immunotherapy (OIT) with baked milk for 6 months. The tolerance was assessed after 2 years follow up. Results: Thirty percent of patients presented anaphylaxis of different degrees of severity as first manifestation of CMA. Sixty-two patients followed OIT or an accelerated reintroduction of milk. Ten patients (14.28%) did not obtain tolerance to milk within 2 years. A larger wheal in SPT and higher sIgE to milk, casein and betalactoglobulin were noted in patients with positive OFC. A basal level of <2.5 kU/l for sIgE to milk and <11.73 kU/l for sIgE to caseins predicted the occurrence of tolerance in patients with all types of clinical manifestations, including anaphylaxis. Conclusion: Basal levels of sIgE to milk and casein may help to identify patients that could become tolerant to milk.

Highlights

Cow milk allergy (CMA) is the most common food allergy in children, with an estimated prevalence of 0.5% to 3% in the pediatric population below 1 year old [1]
Ten patients (14.28%) did not obtain tolerance to milk within 2 years after the first evaluation and positive diagnosis of cow milk allergy
The present study showed that high levels of sIgE to milk and casein may predict the persistence of CMA despite oral immunotherapy

Summary

Introduction

Cow milk allergy (CMA) is the most common food allergy in children, with an estimated prevalence of 0.5% to 3% in the pediatric population below 1 year old [1]. The incidence of self-reported allergy varies between 1.2% to 17%, while the rate of prevalence for milk allergy confirmed by an oral food challenge test is lower, between. An IgE-mediated cow milk allergy is a type I hypersensitivity reaction, and the clinical manifestations occur within minutes to 2 h after milk ingestions. This form represents almost 60% of CMA cases, but this estimation could vary according to patient age and geographical area [1,7]

Objectives

Methods

Results

Discussion

Conclusion