Predicting food challenge outcomes for baked milk: role of specific IgE and skin prick testing

Bartnikas, Lisa M.; Sheehan, William J.; Hoffman, Elaine; Permaul, Perdita; Dioun, Anahita F.; Friedlander, James; Baxi, Sachin N.; Schneider, Lynda C.; Phipatanakul, Wanda

doi:10.1016/j.anai.2012.07.026

Cited by 75 publications

(63 citation statements)

References 20 publications

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“…Consistent with other cohorts evaluating baked milk challenges, gender, history of asthma or eczema, and history of anaphylaxis were not able to clinically predict outcome of oral challenge [5, 6, 21]. Bartnikas et al [6], however, reported that younger children were more likely to be baked milk reactive.…”

Section: Discussionsupporting

confidence: 54%

“…In recent years, evidence shows that 70–80 % of milk-allergic patients can eat baked milk products without reaction [5, 6], referred to as baked milk tolerance. This tolerance is due to conformational changes in milk proteins with whey more susceptible and casein more resistant to heat degradation [7].…”

Section: Introductionmentioning

confidence: 99%

“…For baked milk, a retrospective study found that no patient with SPT <7 mm reacted to baked milk [6]. However, the study did not prove that patients were allergic to unheated milk.…”

Section: Introductionmentioning

confidence: 99%

“…The 95 % specificity level of cow’s milk and casein was determined in one cohort to be 24.5 and 20.2 kU/L, respectively [17]. However, a patient with undetectable sIgE to cow’s milk, including casein, can still react to baked milk [6]. Sensitivity of sIgE to casein is therefore less than optimal and medically observed oral food challenge is still required.…”

Section: Introductionmentioning

confidence: 99%

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Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children

Kwan

Asper

Lavi

et al. 2016

Allergy Asthma Clin Immunol

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BackgroundCow’s milk allergy is one of the most common food allergies affecting young children. A subset of milk-allergic individuals can eat baked milk without allergic symptoms which is beneficial in terms of prognostication and liberalization of the diet. A retrospective study suggested that skin prick testing (SPT) with a baked milk (muffin) slurry may provide a sensitive means of predicting the outcome of a medically supervised baked milk oral food challenge. We evaluated the predictive value of SPT with baked milk to identify unheated milk-allergic children who are able to safely eat baked milk.MethodsChildren aged 2–16 years with a prior history of reaction to milk and a milk extract SPT of 8–14 mm were recruited. Investigator-blinded SPT to muffin slurry and powdered milk in triplicate and specific IgE (sIgE) to casein and milk were performed. Graded oral challenge to egg-free baked milk muffins (total 2.6 gm milk protein) was performed in the hospital. Reliability of tests was analyzed for intraclass correlation. Statistical significance for clinical characteristics of population and muffin testing versus baked milk reactivity was calculated with Fisher exact test for dichotomous and t-test for continuous variables. Wilcoxon rank sum test was used to compare immunological characteristics between individuals who tolerated or reacted to baked milk. Fitted predicted probability curves and ROC curves were generated.ResultsThirty-eight children were consented and 30 met study criteria. The muffin SPT and casein sIgE were significantly different in those who passed versus failed baked milk challenge. Negative (<3 mm) baked milk tests were found in 8/30 children (27 %) and were associated with non-reactivity to baked milk (p = 0.01) with a sensitivity of 1 (0.70–1.00). All children with negative SPT for baked milk passed the oral challenge. Specificity was 0.41 (0.19–0.67). The optimal decision point for the muffin SPT was 4 mm and the casein sIgE was 6 kU/L. The powdered milk test was not helpful.ConclusionsSkin prick testing with a baked milk (muffin) slurry may have a role in clinical practice to identify baked milk tolerance in milk-allergic patients.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

“…For baked milk, a retrospective study found that no patient with SPT <7 mm reacted to baked milk [6]. However, the study did not prove that patients were allergic to unheated milk.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children

Kwan

Asper

Lavi

et al. 2016

Allergy Asthma Clin Immunol

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“…Bartnikas et al reported that 83% of the milk-allergic children they challenged were able to tolerate baked milk in their diet. In particular, they found that no child with an SPT wheal diameter <7 mm failed the baked milk challenge, and that 90% of those with a wheal diameter under 12 mm passed the baked milk challenge 39. Elimination diets are detrimental to health as they can be associated with nutritional deficiencies and increased anxiety among patients and families.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and management of food allergies: new and emerging options: a systematic review

O’Keefe¹,

Schryver²,

Mill³

et al. 2014

JAA

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It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.

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Oral Tolerance and Prognosis in Food Allergy

Stukus

2020

Pediatric Food Allergy

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Predicting food challenge outcomes for baked milk: role of specific IgE and skin prick testing

Cited by 75 publications

References 20 publications

Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children

Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children

Diagnosis and management of food allergies: new and emerging options: a systematic review

Oral Tolerance and Prognosis in Food Allergy

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