Molecular diagnosis of cow's milk allergy

Abstract

Accurate diagnosis of CMA is challenging and essential. The determination of the immunoglobulin E (IgE)-mediated response to sequenced and characterized allergens may be more useful in predicting the presence and severity of clinical allergy than the currently used skin or blood tests performed with whole extracts. However, as component recognition pattern heterogeneity is observed in different areas, further clinical studies are essential to correlate useful molecular diagnostics and biological markers with disease and patient profiles. Until such markers are found and validated in different age groups, oral food challenge remains the reference standard for the diagnosis of CMA.

Patient characteristics of children with cow’s milk allergy presenting with an allergy to extensively hydrolyzed whey and/or casein formulae used as part of an elimination diet

“…Even though we do not have these methods at out disposal in basic allergological diagnostics, they are used in scientific applications. Discoveries in the fields of molecular biology and physics have always been followed by the development of increasingly non-allergenic therapeutic preparations to be used in the treatment of food allergy [67][68][69].…”

“…Cow's milk protein allergy is mostly IgE-mediated, hence both the determination of the concentration of allergen-specific IgE (asIgE) in blood serum and the skin prick and skin application food tests (SPT and SAFT, respectively) may be of significant assistance in making the diagnosis. While tests measuring the asIgE level in blood serum and/or tests such as the SPT are valuable from a diagnostic viewpoint, they are not sufficient to diagnose food allergy [15]. The medical history, the clinical manifestation, and the test results will ultimately indicate which foods should be evaluated in open challenge tests or single-blind/double-blind placebo-controlled food challenges (SBPCFC/DBPCFC), and also indicate whether the challenge tests should be carried out on an inpatient basis and whether they should be postponed [10,16].…”

Diagnosing and Treating Food Allergy

“…In IgE-mediated FA, circulating antibodies recognize specific molecular regions on the antigen surface (epitopes), which are classified according to their specific amino acid sequence (sequential or linear epitopes) or the folding and configuration of their protein chains (conformational epitopes). Subjects with transient FA produce IgE antibodies primarily directed at conformational epitopes (dependent on the protein's tertiary structure), whereas those with persistent FA also produce IgE antibodies against sequential epitopes, which are heat stable [17]. Greater IgE epitope diversity and higher IgE affinity are associated with more severe FA [18].…”

In‐vitro‐Allergiediagnostik aktuell

“…. Bisherige Studien konnten kein eindeutiges Bild liefern, welche Sensibilisierungsbilder mit einer klinisch relevanten Allergie assoziiert sind, so dass weiter Provokationstestungen der Goldstandard zur Überprüfung einer Kuhmilchallergie bleiben [12].…”