Cow's milk (CM) allergy, one of the major food allergies with a prevalence of 2%-3%, 1,2 accounts for 21% of food-induced anaphylaxis in the UK. 3 In Japan, CM is the second most common cause of food allergy in children. Although about 50%-90% of children with childhood-onset CM allergy acquire tolerance by school age, 4,5 children with severe CM allergy that have high CM-specific immunoglobulin E (sIgE) levels and a history of anaphylaxis often have persistent CM allergy. 4,6

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The prevalence of food allergies is increasing globally. 1 Although strict avoidance is mandatory for severe food allergies, accidental ingestion frequently occurs. 2 The frequency of accidental ingestion depends on an individual's threshold for food allergens. 3 An individual's threshold provides information on the maximum tolerable doses and minimum eliciting doses. 4 Although studies have revealed threshold doses for different allergens, 4-8 evidence regarding risk factors for a low threshold dose is limited.Increased specific immunoglobulin E (sIgE) levels are associated with anaphylaxis 9 and severe reactions 10 during oral food challenges (OFCs). Peanut and Ara h 2 sIgE levels have been reported as risk factors for a low threshold dose in the peanut OFC. 11,12 Nevertheless,

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