Molecular Allergy Diagnostics in Children with Cow’s Milk Allergy: Prediction of Oral Food Challenge Response in Clinical Practice

Abstract

Background. Cow’s milk allergy (CMA) is the most common food allergy in early childhood. Children with CMA require a precise and punctual diagnosis. Oral food challenge (OFC) is the gold-standard procedure for diagnosing allergies, but it is laborious and requires a particular setting. The aim of the study was to identify the cutoff value of serum allergen-specific IgE values able to predict a positive response to OFC. Methods. Children with suspected CMA performed OFC with cow’s milk (CM) or derivatives. Total IgE and specific IgE to raw CM, α-lactalbumin, β-lactoglobulin, and casein were measured. Results. Seventy-two children performed OFC, and 30 (41.6%) had a positive response. The significant predictive factors were sensitization to raw CM extract ( p = 0.03 ), α-lactalbumin ( p = 0.013 ), β-lactoglobulin ( p = 0.09 ), and casein ( p = 0.019 ). The cutoff was, respectively: 5.13 kUA/L for raw CM, 1.47 for α-lactalbumin, 1.35 for β-lactoglobulin, and 4.87 for casein. Conclusions. This study allowed us to define a set of cutoff values for CM protein-specific IgE. However, these cutoffs should be interpreted not as a diagnostic tool for CMA but only predictive of response to OFC in a specific territory. Thus, the practical message may be that a value above the cutoff allows a good approximation to identify children to be started on OFC.

Electrical Fields in the Processing of Protein-Based Foods

“…Not only is food allergy prevalence expected to increase globally in future years, but also children with food allergies appear to be more likely to maintain this health condition into late-childhood or even teenage years [161]. The most relevant and common food allergy in infants is cow's milk allergy, presenting a prevalence of 5% in children [162]. Cow's milk allergy can be associated with different allergenic molecules, with Bos d 4 and Bos d 5, corresponding to α-La and β-Lg, respectively, being the main sensitization allergens [163].…”

Molecular Mechanism and Clinical Effects of Probiotics in the Management of Cow’s Milk Protein Allergy

“…Other whey proteins include bovine serum albumin (BSA, Bos d 6), lactoferrin (Lf), and immunoglobulin (Bos d 7). Children with allergies are mostly sensitive to multiple cow’s milk proteins, and more than 50% of the individuals with CMPA produce specific IgEs against casein, β-lactoglobulin, and α-lactalbumin [ 17 , 18 ]. Human IgE antibodies are mainly directed to conformational epitopes; therefore, any changes of the proteins’ structure could influence their immunogenic and allergenic properties, potentially inducing both allergies and tolerance [ 17 ].…”

Food allergy to cow’s milk proteins and meat

“…Сенсибилизация к линейным эпитопам является маркером длительной и стойкой АБКМ. У больных транзиторной АБКМ был выявлен низкий уровень sIgE к конформационным IgEсвязывающим эпитопам, которые разрушаются при термической обработке [31]. Линейные эпитопы преобладают в казеиновых компонентах КМ, а конформационные -в сывороточных белках.…”

“…Самым информативным методом считается молекулярная или компонент-разделённая диагностика [31,58]. Она основана на использовании очищенных нативных или рекомбинантных молекул аллергенов с применением тест-систем для единичных («ImmunоCap») или множественных («ImmunoCap ISAC») исследований.…”