Predictive factors for the persistence of cow’s milk allergy

Abstract

Cow's milk allergy (CMA) is usually transient, but recent studies have shown a later acquisition of tolerance to CM. Our aims were to characterize a population of Portuguese children with CMA and to identify predictive factors for the persistence of this food allergy. Children with CMA observed in our Paediatric Allergy Clinic between 1997 and 2006 were selected. Demographic and clinical data were collected from medical records. The group of children who tolerated CM before the age of 2 was compared with the group of children who tolerated CM beyond that age or persisted with CMA until the end of the study. Multivariate logistic regression analysis was used to investigate independent predictive factors for the persistence of CMA beyond the age of 2. In the subgroup of children with IgE-mediated CMA, the acquisition of tolerance was analysed using Cox regression. In this population of 139 children, the majority presented more than one symptom (73%) affecting more than one organ (51%), with cutaneous (81%), gastrointestinal (55%), respiratory (16%) manifestations and/or anaphylaxis (3%). Thirty-two per cent developed asthma, 20% atopic eczema, 20% rhinoconjunctivitis and 19% other food allergies over time. The acquisition of tolerance was different in the whole population versus the subgroup with IgE-mediated CMA: 34%versus 0% at the age of 2, 55%versus 22% at the age of 5 and 68%versus 43% at the age of 10. Immediate allergic symptoms, asthma and other food allergies were independent factors for the persistence of CMA beyond the age of 2. Higher maximum weal diameter on skin prick test to CM and higher maximum level of specific IgE to CM were associated with reduced likelihood of acquiring tolerance in the subgroup of children with IgE-mediated CMA. In conclusion, children with IgE-mediated CMA acquire tolerance to CM at older age. Clinical parameters and allergy tests may be helpful in defining prognosis. CM-allergic children tend to develop other atopic conditions and need specialized follow-up in the long term.

Cow’s milk allergy: Evaluating tolerance through skin-prick test

“…Presence of anaphylaxis was the only clinical aspect that showed significant differences between persistent and tolerant groups (Table 1), as previously shown in the same service by Jacob et al 2 Atopic dermatitis had no significant influence on this difference, as described by Payot et al 13 Factors previously described such as asthma and allergies to other foods were identified as independent predictors for persistent CMPA after the age of 2 years, 14 not observed in the present study.…”

“…Jacob et al, 2 in 2010, evaluating patients with CMPA from the same service, identified that 45% of the individuals were tolerant by the age of 5 years; in our sample, we found that the rate of resolution in the same age range fell to 37.9%. In 2010, Santos et al 14 found tolerance in only 22% of the children aged up to 5 years. Skripak et al, 1 in 2007, found that 21% of the children with CMPA persisted allergic up to the age of 16 years.…”

A Case Report of an African Infant with Cow Milk Allergy and Extensive Atopic Skin Disorders

“…In a prospective study by Martorell et al, which examined 170 infants diagnosed with milk allergy, the authors indicate persistent milk allergy at different ages between 12 and 48 months, which vary considerably from person to person [10]. Additionally the study of Santos et al, also indicated that the larger the value of sIgE, less the likelihood of an individual for developing tolerance [11], and The Sek et al reported that a decrease of about 50 % or 90 % of the values sIgE within a 12 month period associated with a probability of achieving tolerance to 0.31 and 0.66, respectively [12].…”

“…In a prospective study by Martorell et al, which examined 170 infants diagnosed with milk allergy, the authors indicate persistent milk allergy at different ages between 12 and 48 months, which vary considerably from person to person [10]. Additionally the study of Santos et al, also indicated that the larger the value of sIgE, less the likelihood of an individual for developing tolerance [11], and The Sek et al reported that a decrease of about 50 % or 90 % of the values sIgE within a 12 month period associated with a probability of achieving tolerance to 0.31 and 0.66, respectively [12].It is therefore assumed that most clinical features of generalized atopic reaction are non -specific, as the clinical and serological data can be seen in many infectious diseases and diseases with hereditary characteristics. Also if and allergic skin reaction may be second in frequency after gastrointestinal disorders, the extent of the allergic reaction and the intensity of symptoms throughout the body of the infant was examined in this study, combined with poor health conditions, make diagnosis and rapid treatment imperative.…”

Alergia às Proteínas do Leite de Vaca: Uma Nova Era

“…1 Dos doentes com APLV, até 50% desenvolvem alergias a outros alimentos, 9,10 até 40% apresentam asma, 20% eczema atópico e até 30% rinoconjuntivite. 9 No presente caso clínico, a doente tinha história de eczema atópico e asma.…”