Milk Allergy In Children Research Articles

Natural History of Milk Allergy in Young Children

Source: Wood RA, Sicherer SH, Vickery BP, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013; 131(3): 805– 812; doi: 10.1016/j.jaci.2012.10.060Investigators from multiple institutions in the United States conducted a cohort study of infants with cow’s milk allergy to assess the natural history of the disorder, including factors associated with resolution over the first 5 years of life. Children eligible for the study had a diagnosis of cow’s milk allergy based on either a positive physician-supervised oral food challenge or a convincing history of allergic reaction within 1 hour of an isolated ingestion of milk, and sensitization to milk as demonstrated by an elevated milk-specific IgE level (>0.35 kU/L) or a positive skin prick test (SPT) to milk (>3 mm), or a flare of atopic dermatitis (AD) after milk ingestion combined with an elevated milk-specific IgE level (>5 kU/L). At enrollment, IgG4 antibody levels to milk were also measured. Study participants were followed with yearly evaluations. The primary study outcome was resolution of milk allergy.There were 293 enrolled children who met criteria for milk allergy. A majority of milk-allergic infants (178/293) were enrolled between 6 and 12 months of age. Twenty-four infants were given a diagnosis of milk allergy based on AD criteria, and the remainder had a history of an acute allergic reaction to milk ingestion. Of the 293 children with milk allergy, 117 also had other food allergies at initial evaluation, and 74 developed food allergies over the subsequent observation period.The median age of study participants at the time of last follow-up was 66 months. By the last follow-up, 154 of the 293 participants (53%) had experienced resolution of their milk allergy, with a median age of resolution of 63 months. In addition, at 5 years of age, 32 of 155 (21%) children with unresolved milk allergy were able to tolerate at least some baked milk products. The rate of resolution of milk allergy was highest in study participants who had milk-specific IgE levels <2 kU/L and SPT <5 mm at baseline. Significant differences were also noted in infants with no or mild AD compared to those with moderate or severe AD. Baseline IgG4 levels were not predictive of milk allergy resolution.The authors conclude that milk-specific IgE levels, SPT, and severity of AD were predictors of milk allergy resolution and that these 3 factors could be used to compute a composite predictive score that could be applied to individual patients.Dr Nimmagadda has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The prevalence of milk allergy in children is estimated to be 2% to 3%.1 The rate of resolution of milk allergy has possibly decreased, with a higher proportion of children with milk allergy persisting into adolescence and adulthood.2 Previously reported milk allergy resolution has been as high as 76% and as low as 19% across several studies.3 While most clinical studies have shown that milk-specific IgE and SPT are highly predictive of outcomes, the relationship of AD has not been previously evaluated.Additional factors such as tolerance of baked milk products may identify a subset of patients whose milk allergy may resolve. These patients, when identified, should be allowed to consume extensively heated milk products. In fact, this may even accelerate the resolution of milk allergy in these children.4 This contrasts with earlier recommendations to avoid all milk products regardless of reactions.The authors of this study provide a web-based calculator to determine the prognosis of a child’s milk allergy. This calculator can be accessed at www.cofargroup.org.

The natural history of cow's milk allergy in north-eastern Poland

The rate of cow's milk allergy diminishes with age. There is not enough information concerning geographical trends in persistent cow's milk allergy in children. The objective of the study was to evaluate the prevalence of persistent cow's milk allergy in children previously diagnosed with IgE-mediated cow's milk allergy (CMA). Diagnosis of cow's milk allergy was established by a medical history of symptoms associated with exposure to cow's milk, positive skin prick tests with cow's milk, the presence of milk-specific IgE, and by a positive double- or single-blind placebo-controlled food challenge with milk confirmed by a positive open-controlled milk challenge. A second oral challenge was performed after at least one year of a milk-free diet and children with a positive oral milk rechallenge were diagnosed as having a persistent CMA. Two hundred ninety-one children, 2-14 years of age (mean 5.30±3.16 years, 95% CI, 5.02-5.62 years) completed the study. Persistent CMA was diagnosed in 79 patients (27.1%). Two hundred twelve children (72.9%) outgrew their allergy to cow's milk at a mean age of 5 years after an average time of 16.4±0.8 months on an elimination diet. Eighty percent of children below 3 years of age became milk tolerant. Milk-specific IgE (p=0.018) and history of paternal bronchial asthma and/or rhinitis (p=0.020) were associated with persistence of cow's milk allergy in regression analysis. An age above 3 years, as well as features of atopy, individual and familial, may be associated with a risk of delayed tolerance to milk in children.

Cow’s milk allergy in children: 9 years experience of Dr. Behcet Uz Children’s hospital, Izmir

Objective: Cow’s milk allergy is the most frequent food allergy in childhood. Delayed diagnosis may cause a number of systemic dysfunctions, while incorrect diagnosis may result in deficient nutrition of the mother and the child. As in other types of allergies, food allergy is also a growing problem in recent years. Our aim was to determine the characteristics of our patients allergic to cow’s milk, and see if there was an increasing trend. Material and Methods: The study was of retrospective and cross-sectional design. Patient data were collected from Pediatric Allergy Department patient files. Cases of food allergy were reviewed and patients fulfilling the criteria of cow’s milk allergy were included in the study. Results: A total of 105 cases with cow’s milk allergy out of 264 food allergies who were followed up between 2003-2011 were investigated. Most of the patients were under 2 years of age (78.1%), were males (62.9%) and presented with a history of allergy (79.1%). IgE mediated cases constituted the majority (75.2%). More than half of the patients admitted in 2010 and 2011. This was mostly due to the increased number of patients less than twelve months of age (p=0.015). Most frequently involved system was skin (67.5%) and multisystem involvement was 15.7% Conclusion: A detailed history is the key element of diagnosing cow’s milk allergy. There is a considerable number of cases within the first year of life which may present with different signs and symptoms. Although not a life threatening situation, correct diagnosis is vital as nutrition is a key component in the development and growth of child.

Milk-induced wheezing in children with asthma

BackgroundFood allergy has been gaining increasing attention, mostly as causing gastrointestinal and cutaneous reactions. Its role in asthma seems to be under-recognised. ObjectivesThis study's aim is to explore the frequency of involvement of a common food, namely cow's milk, in childhood asthma. Methods32 children (5 months to 11 years; median 24 months; mean 34 months) with asthma and a suspected history of cow's milk allergy were studied. They underwent skin prick testing (SPT) and specific IgE (sIgE) testing to whole cow's milk (WCM), casein, α-lactalbumin, and β-lactoglobulin, followed by single-blind oral milk challenge. ResultsReactions to milk challenge occurred in 12 (37.5%) including wheezing in 5 (41.7%, or 15.6% of the whole group). Children who developed wheezing at the time of challenge were younger than those who had negative challenge (23.0 months vs. 34.8 months). Challenge was positive in 33.3% of subjects who had a positive SPT, and SPT was positive in 50% of challenge-positive subjects. Regarding sIgE, challenge was positive in 26.7% of sIgE-positive subjects, and sIgE was positive in 33.3% of challenge positive subjects. Skin or serum testing with individual protein fractions did not seem to add significant advantage over testing with WCM alone. ConclusionThis study shows that cow's milk can cause wheezing in children with asthma. Although SPT seemed to be more reliable than sIgE testing, both had suboptimal reliability. It is worth considering possible milk allergy in children with asthma, particularly when poorly controlled in spite of proper routine management.

Dietary Baked Milk Accelerates the Resolution of Cow’s Milk Allergy in Children

To evaluate outcomes of children with cow’s milk allergy that incorporate extensively heated (baked) milk products into the diet.Eighty-nine subjects aged 0.5 to 21 years were recruited from a large academic pediatric allergy clinic. Subjects were diagnosed with milk allergy based on a positive skin prick test (SPT) or detectable serum milk-specific immunoglobulin (Ig) E and history of allergic reaction to milk. Subjects were also included if milk-specific IgE or SPT responses were >95% of predicted value for clinical reactivity.Subjects underwent an initial baked milk oral challenge with a muffin containing 1.3 g of milk protein baked at 350°F for 30 minutes. Subjects who were reactive to baked milk (n = 23) were instructed to completely avoid all forms of milk and were offered a repeat challenge ≥6 months from the initial challenge. Patients who were tolerant to baked milk (n = 65) were instructed to incorporate baked milk products daily into their diets. After ≥6 months, these patients were offered challenges to baked cheese products (cheese pizza with 4.6 g of milk baked at 425°F for >13 minutes). After 6 months of tolerating baked cheese, subjects were offered challenges to unheated milk. A historical comparison group of subjects who fulfilled the inclusion criteria but were not initially ingesting baked milk was included. Serum samples were collected for measurement of IgE and IgG4 antibodies to milk, casein, and beta-lactoglobulin. All food challenges were performed openly.Challenges were conducted over a median of 37 months (range: 8–75 months). In the group of 65 subjects initially tolerant to baked milk, 39 (60%) now tolerated unheated milk. Over the same time period, 2 (9%) of the 23 subjects who were originally reactive to baked milk tolerated unheated milk. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk–reactive subjects (P < .001). Subjects who introduced dietary baked milk were 16 times more likely than comparison group subjects to become unheated milk tolerant (P < .001). Median casein IgG4 levels in baked milk–tolerant group increased significantly (P < .001), but median milk IgE values did not change significantly.Tolerance of baked milk suggests a transient IgE-mediated cow’s milk allergy. The addition of baked milk to the diet in children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.This and other supportive studies now suggest a change to the mantra of strict avoidance of known food allergens for a subset of foods. For milk-allergic patients, allergists can now offer baked milk oral food challenges with the hope of accelerating clearance of their food allergy. Additional studies directed at determining which patients would be at increased risk for reacting to a baked milk challenge would be helpful because those reacting sometimes experience anaphylaxis.

IgE-Mediated Cow’s Milk Allergy in Children

The age at which the majority of children outgrow cow's milk allergy now appears to be later than previously reported. Recent studies have attempted to elucidate factors that may help prevent cow's milk allergy, assess markers of persistence, and evaluate the usefulness of new diagnostic methods. Strict avoidance of cow's milk has been the mainstay of treatment. However, given the potential nutritional, social, and immunologic ramifications of cow's milk elimination from a child's diet, there has been a focus on reevaluating this therapeutic approach.

Oral immunotherapy for cow's milk allergy

Cow's milk allergy (CMA) is common in children and may lead to severe systemic reactions. Avoidance of the ingestion of cow milk is the only effective approach, but this does not exclude the inadvertent or accidental ingestion, or the assumption of milk hidden in other foods. As no pharmacological treatment is available, specific desensitization has been considered an attractive strategy. In the last years, several trials of oral desensitization to cow milk, with different protocols, were published. Overall the results were favourable and demonstrated the achievement of a full tolerance in a high percentage of children. Mild side effects that can be easily managed by slowing the desensitization were reported frequently. The discontinuation of the procedure was necessary in less than 20% of children, on average, due to severe side effects. Oral immunotherapy (oral desensitization) seems to be a promising treatment strategy for cow milk allergy in children that can be applied also to other foods such as eggs or peanuts.

The usefulness of casein-specific IgE and IgG4 antibodies in cow's milk allergic children

BackgroundCow's milk allergy is one of the most common food allergies among younger children. We investigated IgE antibodies to milk, and IgE and IgG4 antibodies to casein, α-lactalbumin and β-lactoglobulin in cow's milk allergic (CMA) and non-allergic (non-CMA) children in order to study their clinical usefulness.MethodsEighty-three children with suspected milk allergy (median age: 3.5 years, range: 0.8-15.8 years) were diagnosed as CMA (n = 61) or non-CMA (n = 22) based on an open milk challenge or convincing clinical history. Their serum concentrations of allergen-specific (s) IgE and IgG4 antibodies were measured using ImmunoCAP®. For the sIgG4 analysis, 28 atopic and 31 non-atopic control children were additionally included (all non-milk sensitized).ResultsThe CMA group had significantly higher levels of milk-, casein- and β-lactoglobulin-sIgE antibodies as compared to the non-CMA group. The casein test showed the best discriminating performance with a clinical decision point of 6.6 kUA/L corresponding to 100% specificity. All but one of the CMA children aged > 5 years had casein-sIgE levels > 6.6 kUA/L. The non-CMA group had significantly higher sIgG4 levels against all three milk allergens compared to the CMA group. This was most pronounced for casein-sIgG4 in non-CMA children without history of previous milk allergy. These children had significantly higher casein-sIgG4 levels compared to any other group, including the non-milk sensitized control children.ConclusionsHigh levels of casein-sIgE antibodies are strongly associated with milk allergy in children and might be associated with prolonged allergy. Elevated casein-sIgG4 levels in milk-sensitized individuals on normal diet indicate a modified Th2 response. However, the protective role of IgG4 antibodies in milk allergy is unclear.

Oral desensitization for milk allergy in children

The purpose of this review is to research current evidence on cow's milk oral immunotherapy for the treatment of cow's milk allergy (CMA). The specific, active treatment for IgE-mediated food allergy included CMA, which is currently being investigated in human trials. Allergen-specific approaches include oral, sublingual and epicutaneous immunotherapy. Reports on oral immunotherapy (OIT) for the treatment of milk allergy have been more extensive and carried out mostly with native proteins. The aim of OIT with cow's milk is the achievement of desensitization or tolerance by patients suffering from CMA. Desensitization state can be achieved by approximately 36-92% of the children treated with specific immunotherapy; the rate of permanent tolerance is unknown. Longer duration of desensitization may result in permanent tolerance. The possibility of adverse events or reactions during OIT is quite frequent. Side-effects have been reported by patients in all published studies. OIT as an active treatment for CMA represents an emerging reality. Before this treatment can be used in clinical practice, additional studies are needed. Currently, many issues remain unanswered: severity and type of food allergy responsive to specific immunotherapy, degree of protection, 'shared schedules' of desensitization(s) in research settings and well established risk-to-benefit ratio. However the field of specific, active treatment of food allergy is poised for clinically important advances.

The availability and cost of a milk-free diet for cow's milk protein allergy

Background: Cow's milk protein allergy (CMPA) is the most common food allergy, and adherence to a milk-free diet is essential, particularly in immunoglobulin E-mediated CMPA sufferers (Benhamou et al., 2009). No studies have looked into the practical aspects of a milk-free diet. The aim of this project was to evaluate how the availability and cost of a milk-free diet compares with that of one containing cow's milk protein. Methods: A cross-sectional survey was conducted in the London Borough of Harrow and three major superstores in an urban setting (inclusion criteria of ≥25 000 sq ft) were randomly selected. Two shopping baskets were created; basket A with commonly consumed foods (bread, biscuits, milk, packaged fruit/vegetable salads, and ready meals which contained ≥12% protein from nondairy protein sources) based on the Eatwell plate (Food Standards Agency, 2007), and basket B with their cow's milk-free alternatives. The price and number of varieties were recorded and analysed for each food group per basket. Pearson's chi-squared and Wilcoxon-rank sum tests were conducted for availability and cost of each food type in both baskets. Results: The availability of foods suitable for a CMPA diet (basket B) was lower than basket A: 74% bread, 15% biscuits, 26% milk and 25% ready meals compared to 26%, 85%, 74% and 75%, P-values of 0.001, 0.002, 0.001 and 0.005, respectively. The availability of fruit/vegetable salads was not statistically significant between the two baskets. Regarding cost, bread in basket A was found to be significantly more expensive than in basket B, whereas milk substitutes (all superstores) and ready meals (superstore 2 only) were significantly more expensive in basket B (Table 1). The cost of biscuits and fruit/vegetable salads between the two baskets was not significantly different. Table 1. Median cost of foods in standard basket A and CMPA basket B (pence/100 g) Basket Superstore 1 Superstore 2 Superstore 3 A B P A B P A B P Bread 17.3 12.5 0.001 16.4 15.3 0.001 17.1 14.9 0.008 Biscuits 25.1 24.8 0.651 24.5 12.2 0.161 27.1 21.3 0.390 Milk or substitutes 8.5 12.5 0.002 7.8 9.4 0.001 7.9 12.4 0.003 Ready meals 63.4 70.1 0.592 54.1 66.2 0.004 61.1 66.0 0.390 Fruit/vegetable salads 50.0 65.3 0.781 33.3 49.2 0.223 65.1 62.5 0.803 Discussion: A similar previous study has investigated the practical aspects of a gluten-free diet and found that this is typically more restrictive than its alternatives (Lee et al., 2007). The findings from the present study provide further evidence that specialist diets are generally more expensive and less available than an unrestricted diet. This could present a barrier to people trying to follow a special diet and might be addressed by increasing awareness of the need for milk-free products by manufacturers and retailers. Dietitians have a role to play in this and in producing CMPA resources and providing education that takes account of barriers like cost and availability. Conclusions: It can be concluded from this study that, overall, a milk-free diet is less accessible and more expensive than an unrestricted milk-containing diet.

Dietary baked milk accelerates the resolution of cow’s milk allergy in children

The majority (approximately 75%) of children with cow's milk allergy tolerate extensively heated (baked) milk products. Long-term effects of inclusion of dietary baked milk have not been reported. We report on the outcomes of children who incorporated baked milk products into their diets. Children evaluated for tolerance to baked milk (muffin) underwent sequential food challenges to baked cheese (pizza) followed by unheated milk. Immunologic parameters were measured at challenge visits. The comparison group was matched to active subjects (by using age, sex, and baseline milk-specific IgE levels) to evaluate the natural history of development of tolerance. Over a median of 37 months (range, 8-75 months), 88 children underwent challenges at varying intervals (range, 6-54 months). Among 65 subjects initially tolerant to baked milk, 39 (60%) now tolerate unheated milk, 18 (28%) tolerate baked milk/baked cheese, and 8 (12%) chose to avoid milk strictly. Among the baked milk-reactive subgroup (n= 23), 2 (9%) tolerate unheated milk, and 3 (13%) tolerate baked milk/baked cheese, whereas the majority (78%) avoid milk strictly. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk-reactive subjects (P< .001). Subjects who incorporated dietary baked milk were 16 times more likely than the comparison group to become unheated milk tolerant (P< .001). Median casein IgG(4) levels in the baked milk-tolerant group increased significantly (P< .001); median milk IgE values did not change significantly. Tolerance of baked milk is a marker of transient IgE-mediated cow's milk allergy, whereas reactivity to baked milk portends a more persistent phenotype. The addition of baked milk to the diet of children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.

Camel milk: An alternative for cow's milk allergy in children

Treatment of cow's milk allergy (CMA) in children includes avoidance of cow's milk and providing a milk substitute. This study was designed to determine whether CMA children could safely consume camel's milk as an alternative, and skin-prick test (SPT) to camel's milk could be a reliable tool in selecting them. Between April 2007 and February 2010, children with confirmed CMA seen at the Allergy-Immunology Clinic, Hamad Medical Corp., were enrolled into this prospective cohort study. Subjects had a detailed history and medical examination, complete blood count with differential count, total serum IgE, and specific IgE test and SPT to cow's milk. Patients with positive SPT and an elevated cow's milk-specific IgE had negative SPT to camel's milk. Of 35 children (23 male and 12 female children) aged 4-126 months (median, 21 months), 23 patients (65.7%) presented with acute urticaria, 17 (48.6%) with atopic dermatitis, 9 (25.7%) with anaphylaxis, 8 (22.9%) with failure to thrive, and 5 (14.3%) with chronic vomiting. Twenty-eight patients (80%) had family history of allergy. Twenty-six patients (74.3%) were breast-fed for ≤18 months. Mean white blood cell count was 9860.5 cells/μL, absolute eosinophil count was 1219 cells/μL, IgE was 682 IU/mL, and cow's milk-specific IgE was 22.01 kU/L. Only 7 patients (20%) had positive SPT to camel's milk and 28 (80%) were negative to camel's milk. All patients with negative SPT took camel's milk without any reactions. In children with CMA, SPT is a reliable clinical test in ruling out reactivity to camel's milk so these children could safely take camel's milk as an alternative nutrient.

Natural Course of Cow's Milk Allergy in Children with Atopic Dermatitis

Cow's milk is one of the most common food allergens in children with atopic dermatitis (AD). This study was conducted to describe the natural course of cow's milk allergy in children with AD, and to identify factors predictive of outcome. To accomplish this, we reviewed the medical records of 115 children who were diagnosed with AD and cow's milk allergy before 24 months of age to evaluate their clinical characteristics and prognostic factors. During a follow-up period of 24 to114 months, the median age for tolerance to cow's milk was found to be 67 months. Multivariate analysis using the Cox proportional hazard model revealed that the peak cow's milk-specific IgE level within 24 months after birth was the most important factor for prediction of the outcome of cow's milk allergy. In conclusion, half of the children younger than 24 months of age with AD and cow's milk allergy could tolerate cow's milk at 67 months of age. The peak cow's milk-specific IgE level within the first 24 months of birth is useful to predict the prognosis of cow's milk allergy in children with AD.

Basophil activation test based on the expression of CD203c in the diagnostics of cow milk allergy in children

BackgroundDetection of allergen-induced basophil activation by flow cytometry has been shown to be a useful tool for allergy diagnosis.ObjectiveThe aim of this study was to assess the potential of this technique for the diagnosis of pediatric cow milk allergy.Material and methodsThe quantification of total and specific IgE and basophil activation test were performed to evaluate cow milk allergic (n = 9), and non-allergic children (n = 15).ResultsAllergen-induced basophil activation was detected as a CD203c up-regulation. The expression of CD203c antigen on basophils was measured with flow cytometry. The antigen CD203c was detected on 15.4 ± 10.2% basophils from allergic children after incubation with specific allergens in concentration 1:10, whereas in the control group there were 3.0 ± 1.5% of basophils positive for this molecule (P < 0.05). Stimulation with allergen diluted 1:500 resulted in activation of 15.3 ± 11.2% of basophils in allergic children and 3.8 ± 2.3% of cells in the control group (P < 0.05). Positive results of an allergenicity test (above the cut- off level of 10%) were obtained in 7 out of the 9 allergic children. In 5 cases, the cutoff level was reached with both dilution of allergens (1:10 and 1:500). In 1 patient, positive stimulation was observed after stimulation with allergen diluted 1:10 and in another case only 1:500 resulted in stimulation of more then 10% of basophils. In no child of the control group, stimulation above 10% was noted.ConclusionsThis study demonstrates that the analysis of allergen-induced CD203c up-regulation with flow cytometry is a reliable tool for the diagnosis of cow milk allergy in pediatric patients, with sensitivity similar to routine diagnostic tests and a higher specificity.

Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet

The basic treatment for cow's milk allergy (CMA) is the elimination of all cow's milk proteins (CMP) from the diet. This study aimed at characterizing the diet of children with a diagnosis of CMA, to assess the degree of adherence to the elimination diet and to evaluate the factors associated with the adherence and age of recovery. From a birth cohort study, food records of 267 children diagnosed with CMA were studied to define how strictly the elimination diet was adhered to. Subsequent food records were studied to assess the age at reintroduction of milk products in the child's diet. The families adhered to the elimination diet of the child with extreme accuracy in 85% of the cases. Older and monosensitized children had more often small amounts of CMP in their diet, possibly because of the absence of nutritional information by a dietitian/nutritionist. Adherence to the diet was neither related to any other sociodemographic factor studied nor to the age at reintroduction of milk products into the diet. The therapeutic elimination diet of children diagnosed with CMA was well adhered to. Low intakes of vitamin D, calcium, and riboflavin are of concern in children who follow or have followed a cow's milk-free diet.

Basophil Activation Marker CD203c Is Useful in the Diagnosis of Hen’s Egg and Cow’s Milk Allergies in Children

Background: The diagnosis of food allergy (FA) is usually based on oral food challenge tests (OFC). However, OFCs occasionally induce severe adverse reactions. CD203c expression on basophils is emerging as a potential diagnostic index. We evaluated whether CD203c expression on basophils would be a useful marker of OFC-associated symptoms in hen’s egg and cow’s milk allergies in children. Methods: Seventy-one patients who had been diagnosed with FA based on OFCs or a convincing history of FA symptoms in the Department of Pediatrics, Sagamihara National Hospital, were recruited. CD203c expression was assessed after stimulation with antigens (egg white, ovomucoid, milk or casein) using allergenicity kits. The CD203c stimulation index (SI = the allergen-induced CD203c expression level divided by the baseline expression level) and the threshold of CD203c expression (the minimum concentration of antigen to induce CD203c SI ≧2) were analyzed in association with tolerance acquisition. Results: For the CD203c SI, the areas under the receiver-operating characteristic curve were 0.72 for egg white, 0.82 for ovomucoid, 0.84 for milk and 0.67 for casein. The positive predictive value for the threshold of CD203c expression was 94.7% for egg white, 100% for ovomucoid, 85.7% for milk and 75.0% for casein. Conclusions: Assessment of food antigen-induced CD203c expression on basophils is useful to determine if children will outgrow FA as well as in decision making regarding whether or not to perform OFCs.

Cow's milk protein allergy in children: a practical guide

A joint study group on cow's milk allergy was convened by the Emilia-Romagna Working Group for Paediatric Allergy and by the Emilia-Romagna Working Group for Paediatric Gastroenterology to focus best practice for diagnosis, management and follow-up of cow's milk allergy in children and to offer a common approach for allergologists, gastroenterologists, general paediatricians and primary care physicians.The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas. Cow's milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough, vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis. Late reactions due to cow's milk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy. An overview of acceptable means for diagnosis is included. According to symptoms and infant diet, three different algorithms for diagnosis and follow-up have been suggested.

An overview of cow's milk allergy in children.

Food allergies have increased over the past decade and are an important problem in daily clinical practice. They affect 6% of children and 3 to 4% of adults. Furthermore, around 20% of the population falsely believe that they are allergic to some foods and follow unnecessarily restrictive diets. For infants, the problem is even more acute as they need appropriate feeding in order to achieve normal growth and avoid bone and metabolic problems. Although any food can cause a reaction, few foods are responsible for the large majority of the symptoms: i.e., milk, eggs, wheat, peanuts, nuts, fish, shellfish. Of these, cow's milk allergy is frequently suspected in small children. It can be responsible of a variety of symptoms and can be caused by IgE-mediated or non-IgE-mediated reactions. The diagnosis relies on a detailed history, skin tests, laboratory tests, an elimination diet and food challenges. The overall natural evolution of the disease is favourable with most patients achieving tolerance to milk by the age of five years, but some patients will remain allergic for life.

An overview of cow's milk allergy in children.

Food allergies have increased over the past decade and are an important problem in daily clinical practice. They affect 6% of children and 3 to 4% of adults. Furthermore, around 20% of the population falsely believe that they are allergic to some foods and follow unnecessarily restrictive diets. For infants, the problem is even more acute as they need appropriate feeding in order to achieve normal growth and avoid bone and metabolic problems. Although any food can cause a reaction, few foods are responsible for the large majority of the symptoms: i.e., milk, eggs, wheat, peanuts, nuts, fish, shellfish. Of these, cow's milk allergy is frequently suspected in small children. It can be responsible of a variety of symptoms and can be caused by IgE-mediated or non-IgE-mediated reactions. The diagnosis relies on a detailed history, skin tests, laboratory tests, an elimination diet and food challenges. The overall natural evolution of the disease is favourable with most patients achieving tolerance to milk by the age of five years, but some patients will remain allergic for life.

Goat's milk allergies in children following specific oral tolerance induction to cow's milk

Being allergic to goat and sheep’s milk whilst having a good tolerance to cow’s milk is relatively uncommon. For cow’s milk allergy, keeping to a dairy-free diet is the recommended treatment and the patient is advised against introducing milk from other ruminants due to the existence of cross-reactivity between species. When there is not a spontaneous evolution towards tolerance from four years of age, the allergy is considered persistent. Recently, there has been a move to treat those patients with specific oral tolerance induction (SOTI). The results are good and enable patients to follow a diet without any cow’s milk restrictions. It would seem logical to suppose that induced artificial tolerance to cow’s milk proteins could extend to all dairy proteins regardless of their animal origin, as usually occurs in natural tolerance. However, some of our patients treated in this way have suffered allergic reactions after having eaten goat and sheep cheese. We report two cases of an IgE-mediated allergy to goat and sheep’s milk without any actual clinical CMA.