Natural history of cows' milk allergy in children: immunological outcome over 2 years

Hill, David; Firer, Michael A.; Ball, G.; Hosking, C. S.

doi:10.1111/j.1365-2222.1993.tb00307.x

Cited by 100 publications

(73 citation statements)

References 21 publications

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“…In our case series, none of these proved a significant predictor of residual disease activity. This has also been observed in other CMA studies [24, 25]. For milk allergy, IgE binding to certain linear epitopes seem to predict persistence of allergy [26,27,28].…”

Section: Discussionsupporting

confidence: 57%

Reintroduction of Cow’s Milk in Milk-Allergic Children: Safety and Risk Factors

Vassilopoulou

Konstantinou²,

Kassimos³

et al. 2008

Int Arch Allergy Immunol

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Background: Although development of clinical tolerance is the rule in allergy to cow’s milk (CM), food challenges are required in order to reintroduce CM into the patient’s diet. Less ‘invasive’ procedures able to predict tolerance would be useful as clinical tools. The purpose of this study was to identify potential risk factors for clinical reactivity in CM-allergic children assessed for CM reintroduction. Methods: One hundred and sixteen open challenges performed in children 10–47 months old with IgE-mediated allergy to CM, in order to reintroduce CM into the diet, were retrospectively evaluated. Specific IgE (sIgE) levels assessed by the CAP System FEIA and skin prick tests (SPT) were obtained at diagnosis and prechallenge. Demographic parameters and measures of sIgE were evaluated as potential predictors of a positive challenge in univariate and multivariate logistic regression models. Results: Twenty-four out of 116 challenges were positive, 9 of which required the use of adrenaline. In order of performance, prechallenge sIgE <3.94 kU/l, the combination of SPT and sIgE or an SPT wheal <4 mm could correctly predict a negative challenge outcome, whereas values of SPT >7.5 mm or sIgE >25.4 kU/l, or their combination, had a high positive predictive value. The presence of atopic dermatitis did not affect the predictive accuracy of these values. Conclusions: Milk sIgE level prechallenge is a useful predictor of challenge outcome in patients with milk allergy. SPT do not offer an additional predictive value, but can be used when sIgE is not available.

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Section: Discussionsupporting

confidence: 57%

Reintroduction of Cow’s Milk in Milk-Allergic Children: Safety and Risk Factors

Vassilopoulou

Konstantinou²,

Kassimos³

et al. 2008

Int Arch Allergy Immunol

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“…This observation was supported by studies with RAST, skin test, histamine release, and blast transformation of lymphocytes, among other methods (4,(6)(7)(8)(9)(10).…”

mentioning

confidence: 49%

Identification of casein as the major allergenic and antigenic protein of cow's milk

Docena

Fernández

Chirdo

et al. 1996

Allergy

186

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The objective of this study was to analyze both the allergenicity and immunogenicity of cow's milk proteins. To this end, 80 milk-atopic patients were selected on the basis of the presence of cow's milk-specific IgE antibodies in serum and compatible clinical history. Fifteen patients allergic to other allergens and 10 nonatopic subjects were studied as controls. The specificity of serum IgG and IgE antibodies was determined by immunoblotting, employing both cow's milk and milk components, i.e., a-and P-casein, P-lactoglobulin, and a-lactalbumin separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The experiments showed that casein-specific IgE antibodies were present in all (80/80) sera examined; 10/80 showed reactivity to P-lactoglobulin, and 5/80 showed reactivity to a-lactalbumin. None of the 25 negative control sera analyzed showed the presence of specific IgE antibodies against milk proteins. These results were similar to those corresponding to the detection, by the radioallergosorbent test, of IgE antibodies against the milk components coupled to paper disks. All sera from milk-atopic patients also showed IgE reactivity against a high-molecular-mass fraction that hardly enters the gel. This fraction, after separation by gel filtration and treatment with 0-mercaptoethanol and urea, was shown by SDS-PAGE analysis to be formed by casein monomers. All sera analyzed by immunoblotting reacted against the components corresponding to casein monomers. Inhibition of immunoblotting by adsorption with different milk components confirmed that those high-molecular-mass aggregates are formed by casein components. The results presented here strongly suggest that casein is the major allergenic component of cow's

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“…For example, high initial specific IgE against hen's egg was shown to be associated with a high frequency of persistence [52], and a drop in specific IgE over the course of the disease is thought to indicate the development of tolerance. However, clinically apparent food allergy can persist while serologic markers decline, and specific IgE regularly remains high despite development of tolerance [57,58]. Change in specific skin reactivity also has low diagnostic value in detecting clinical tolerance in individuals.…”

Section: Specific Igementioning

confidence: 99%

“…Similar to peanuts, allergy against tree nuts tends to persist in most patients. Only about 10% outgrow their disease later in life [57].…”

Section: Peanut and Tree Nutsmentioning

confidence: 99%