Objective: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow's milk extract (CM) comparing tolerant and persistent patients. Method: A retrospective cohort study involving database analysis of children with diagnosis of cow's milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher's, Mann-Whitney or Wilcoxon tests and significance level at 5%. Results: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. Conclusion: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.

BackgroundOne important point in cow's milk allergy (CMA) is to stablish predicitve factors in acquiring tolerance. The aim of this study is to evaluate if a ratio of milk components: alpha-lactalbumin (α), beta-lactoglobulin (β), casein (C) and whole milk (WM) can contribute to predict tolerance development.MethodsIt was a retrospective study that included patients with previous diagnosis of CMA evaluated at 6 years old. CMA was defined as a positive double blind placebo-controlled food challenge, open challenge or confirmed anaphylaxis plus positive specific IgE to cow's milk (higher than 3.5 kU/L or positive skin prick test), and tolerance was defined as acceptance of cow milk without previous symptoms. Specific IgE analysis to WM, α, β, and C were performed through Immunocap (Phadia AB). Ratios of milk components and whole milk (α /WM, β/WM, C/WM) were calculated and compared the results in 2 study groups: tolerant and persistent at 6 years old. Since values from both α /WM and β/WM ratios didn't follow a normal distribution, Mann-Whitney test was used to compare groups. For C/WM ratios, Student's t test was used as values were normally distributed.ResultsIt included 49 patients (27 male/22 female), 24 tolerant and 25 persistent. Average age of Immunocap test was 2.7 years (SD = 1.4). Comparing the results from 2 groups, persistent and tolerant it was detected: no difference in α /WM (P = 0.055, Mann-Whitney test), higher levels of β/WM in persistent group (P = 0.023, Mann-Whitney test) and also higher levels of C/WM in persistent group (P = 0.004, Student's t test).ConclusionsHigher ratios involving beta-lactoglobulin or casein components were detected in persistent patients. Thus, evaluating these markers precociously can be helpful in predicting CMA evolution.

No abstract

Amoroso et al.: Difficulties of caregivers of cow's milk allergy patients in understanding the labeling of processed products.

No abstract