Prognostic accuracy of clinical signs and diagnostic tests in cow's milk allergy in newborns

Abstract

The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period. The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1-11years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies. There was a positive correlation between exanthema and confirmed CMA in the neonatal period (R=0.184; p=<0.001; n=361), and hematochezia and confirmed CMA in the neonatal (R=0.203; p<0.001; n=361) and postneonatal period (R=0.215; p=0.042; n=90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA (R=0.275; p=0.009; n=90). No correlation was found between a positive family history of food allergies and CMA in the neonatal (R=-0.66; p=0.398; n=165) and postneonatal periods (R=0.00; p=1.000; n=116). Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.