Evaluation of some predictive parameters for baked milk tolerance in children with cow's milk allergy

Background: Inclusion of baked-milk products to the diet appears to markedly accelerate tolerance to unheated milk compared to a strict avoidance diet.Objective: The present study aims to investigate the predictors of baked-milk tolerance in children with Immunoglobulin E (IgE)-mediated cow’s milk (CM) allergy.Methods: The study included 80 patients diagnosed with IgE-mediated CM allergy upon oral food challenge (OFC) testing at our clinic. Patients who developed and did not develop reactions during OFC with baked milk were compared considering clinical and laboratory parameters.Results: Eighty patients with CM allergy comprised 48 male and 32 female infants with an average age of 7.25 ± 2.45 (3–13) months. We found that 62.5% of them showed tolerance to baked milk in the OFC test performed with cakes containing 2.6-g milk protein. When the patients who tolerated and could not tolerate baked-milk products were compared for test results, we detected a statistically significant intergroup difference regarding diameter of wheal in skin prick test (SPT) performed with muffin slurry, levels of specific Immunoglobulin E (sIgE) in CM, sheep’s milk (SM), goat’s milk (GM), casein, and the amount of unheated milk consumed until a reaction developed in the OFC test performed with unheated milk (P < 0.05).Conclusion: We defined novel decision points based on CM, SM, GM, casein sIgE levels, wheal diameter in SPT with muffin slurry, and the amount of milk ingested during OFC performed with unheated milk that may be useful in predicting outcomes of baked-milk ingestion.

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

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.06.537 ◽

2016 ◽

Vol 62 (6) ◽

pp. 537-543 ◽

Cited By ~ 2

Author(s):

Flavia Valença de Oliveira Neves ◽

Cleonir de Moraes Lui Beck ◽

Andrea Keiko Fujinami Gushken ◽

Glauce Hiromi Yonamine ◽

Ana Paula Beltran Moschione Castro ◽

...

Keyword(s):

Immunoglobulin E ◽

Food Challenge ◽

Cow’S Milk ◽

Significance Level ◽

Prick Test ◽

Cow's Milk ◽

Significant Difference ◽

Wheal Diameter ◽

Skin Prick Tests ◽

The Moment

Summary Objective: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow’s milk extract (CM) comparing tolerant and persistent patients. Method: A retrospective cohort study involving database analysis of children with diagnosis of cow’s milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher’s, Mann-Whitney or Wilcoxon tests and significance level at 5%. Results: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. Conclusion: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.

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Baked Tolerance in Cow’s Milk Allergy: Quite Frequent, Hard to Predict!

International Archives of Allergy and Immunology ◽

10.1159/000511148 ◽

2020 ◽

pp. 1-5

Author(s):

Lisis Karine Vilar ◽

Flávia Alves Araújo ◽

Thalita Pereira Santos ◽

Thatiana Tavares Menezes ◽

Marina F. Cheik ◽

...

Keyword(s):

Food Challenge ◽

Specific Ige ◽

Cross Sectional Study ◽

Cow’S Milk ◽

Cross Sectional ◽

Prick Test ◽

Cow's Milk ◽

Baked Goods ◽

Baked Foods ◽

Baked Milk

Introduction: Cow’s milk protein allergy (CMA) is the most common type of food allergy in childhood and exclusion diet is a challenge for patients. Objective: The study aim was to investigate the frequency of tolerance to baked foods containing milk and evaluate immediate skin prick test (SPT) and specific IgEs for different cow’s milk (CM) protein types as predictors of tolerance to baked foods containing milk for CMA patients. Methods: A cross-sectional study was performed. Fifty-four CMA patients were enrolled and oral food challenge (OFC) was performed with baked product, 6 different milk SPTs and specific IgEs to CM, casein, α-lactalbumin, and β-lactoglobulin. Results: Thirty-nine (72.2%) patients tolerated OFC with baked milk cupcake. CM-specific IgE and casein SPT showed statistical difference between positive and negative OFC groups. Probability curves for baked milk tolerance were created for specific CM IgE (Z = 2.542, p < 0.0110) and casein SPT (Z = 2.290, p < 0.0220) using logistic regression. Conclusions: The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. Specific CM IgE and casein SPT demonstrated to be useful predictors in relation to baked milk tolerance.

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Outcomes of Baked Milk and Egg Challenge in Cow’s Milk and Hen’s Egg Allergy: Can Tolerance Be Predicted with Allergen-Specific IgE and Prick-to-Prick Test?

International Archives of Allergy and Immunology ◽

10.1159/000502957 ◽

2019 ◽

Vol 180 (4) ◽

pp. 264-273

Author(s):

Seda Sirin Kose ◽

Suna Asilsoy ◽

Nevin Uzuner ◽

Ozkan Karaman ◽

Ozden Anal

Keyword(s):

Specific Ige ◽

Cow’S Milk ◽

Egg Allergy ◽

Prick Test ◽

Cow's Milk ◽

Hen’S Egg ◽

Baked Milk

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Testing the Cow’s Milk-Related Symptom Score (CoMiSSTM) for the Response to a Cow’s Milk-Free Diet in Infants: A Prospective Study

Nutrients ◽

10.3390/nu11102402 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2402 ◽

Cited By ~ 4

Author(s):

Silvia Salvatore ◽

Elisabetta Bertoni ◽

Federica Bogni ◽

Valentina Bonaita ◽

Chiara Armano ◽

...

Keyword(s):

Symptom Score ◽

Immunoglobulin E ◽

Gastrointestinal Symptoms ◽

Cow’S Milk ◽

P Value ◽

Cow's Milk ◽

Related Symptom ◽

Receiver Operation Characteristic ◽

Ige Mediated ◽

A Prospective Study

The diagnosis of cow’s milk allergy (CMA) is particularly challenging in infants, especially with non-Immunoglobulin E (IgE)-mediated manifestations, and inaccurate diagnosis may lead to unnecessary dietary restrictions. The aim of this study was to assess the accuracy of the cow’s milk-related symptom score (CoMiSSTM) in response to a cow’s milk-free diet (CMFD). We prospectively recruited 47 infants (median age three months) who had been placed on a CMFD due to persisting unexplained gastrointestinal symptoms. We compared data with 94 healthy controls (median age three months). The CoMiSSTM score was completed at recruitment and while on the exclusion diet. In 19/47 (40%) cases a response to the diet occurred. At recruitment CoMiSSTM was significantly higher in cases compared to controls (median score 8 vs. 3; p-value: <0.05), 9 cases had a score ≥12 and 8/9 normalized on CMFD. An oral milk challenge was performed in all 19 responders and six of these had a positive reaction to cow’s milk (CM). In eight infants IgE allergy tests were positive. The receiver operation characteristic (ROC) curve identified a CoMISSTM score of 9 to be the best cut-off value (84% sensitivity, 85% specificity, 80% positive (PPV) and 88% negative predictive value (NPV)) for the response to CMFD. We found CoMiSSTM to be a useful tool to help identify infants with persisting gastrointestinal symptoms and suspected CMA that would benefit from CMFD.

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Atypical Food protein-induced enterocolitis syndrome in children: Is IgE sensitization an issue longitudinally?

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.79 ◽

2021 ◽

Vol 49 (3) ◽

pp. 73-82

Author(s):

Athina Papadopoulou ◽

Theano Lagousi ◽

Elpiniki Hatzopoulou ◽

Paraskevi Korovessi ◽

Stavroula Kostaridou ◽

...

Keyword(s):

Immunoglobulin E ◽

Allergic Diseases ◽

Cow’S Milk ◽

Food Protein ◽

Cow's Milk ◽

T Helper 2 ◽

Term Evaluation ◽

Ige Mediated ◽

Trigger Mechanisms

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a clinically well-characterised, non-Immunoglobulin E (IgE)-mediated food allergy syndrome, yet its rare atypical presen-tation remains poorly understood.Objective: Aim of this study was to present the 10-year experience of a referral centre high-lighting the atypical FPIES cases and their long-term outcome.Methods: FPIES cases were prospectively evaluated longitudinally in respect of food outgrowth and developing other allergic diseases with or without concomitant IgE sensitisation.Results: One hundred subjects out of a total of 14,188 referrals (0.7%) were identified. At pre-sentation, 15 patients were found sensitised to the offending food. Fish was the most frequent eliciting food, followed by cow’s milk and egg. Tolerance acquisition was earlier for cow’s milk, followed by egg and fish, while found not to be protracted in atypical cases. Resolution was not achieved in half of the fish subjects during the 10-year follow-up time. Sensitisation to food was not related to infantile eczema or culprit food, but was related to sensitisation to aeroallergens. In the long-term evaluation, persistence of the FPIES or aeroallergen sensitisation was significantly associated with an increased hazard risk of developing early asthma symptoms. Conclusion: Sensitisation to food was related neither to eczema or culprit food nor to tolerance acquisition but rather to the development of allergic asthma through aeroallergen sen-sitisation. In addition to an IgE profile at an early age, FPIES persistence may also trigger mechanisms switching FPIES cases to a T-helper 2 cells immune response later in life, predis-posing to atopic respiratory symptoms; albeit further research is required.

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Relationship Between Clinical and Laboratory Criteria and Results of Double Blind Placebo Controlled Food challenge (DBPCFC) for the IgE Mediated Cow's Milk Allergy Diagnosis in Pediatric Patients

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2010.12.730 ◽

2011 ◽

Vol 127 (2) ◽

pp. AB184-AB184

Author(s):

A.K.F. Gushken ◽

G.H. Yonamine ◽

A.P.B.M. Castro ◽

U. Doria-filho ◽

A.C. Brandão ◽

...

Keyword(s):

Pediatric Patients ◽

Food Challenge ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Allergy Diagnosis ◽

Double Blind ◽

Double Blind Placebo ◽

Cow's Milk ◽

Ige Mediated

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Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.189 ◽

2021 ◽

Vol 49 (3) ◽

pp. 185-192

Author(s):

Hilal Unsal ◽

Gokce Ozyilmaz Bozat ◽

Melike Ocak ◽

Aysegul Akarsu ◽

Umit Murat Sahiner ◽

...

Keyword(s):

Food Allergy ◽

Preschool Children ◽

Food Challenge ◽

Oral Food Challenge ◽

Cow’S Milk ◽

Cow's Milk ◽

Tree Nuts ◽

Increased Risk ◽

Hen’S Egg ◽

Ige Mediated

Background: The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks.Objective: Documentation of the rate, spectrum, and predictors of positive reactions is instructive.Methods: Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed.Results: A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly consid-ered food groups were cow’s milk (31.8%), hen’s egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow’s milk, 4.9% with hen’s egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03–14.90]), wheat (OR: 3.80, [CI: 1.64–8.84]), and tree nuts (OR: 2.78, [CI: 1.83–4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27–10.28]) was more likely to elicit anaphylaxis.Conclusion: In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC.

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Evaluation of Skin Prick Test and Specific Immunoglobulin E for Diagnosis of Infants with Cow’s Milk Protein Allergy

Zagazig University Medical Journal ◽

10.21608/zumj.2021.55326.2064 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Heba Gamal ◽

Doaa Abo-Alella ◽

Naglaa El-Adawy ◽

Nahed Khater

Keyword(s):

Skin Prick Test ◽

Milk Protein ◽

Immunoglobulin E ◽

Cow’S Milk ◽

Prick Test ◽

Cow's Milk ◽

Specific Immunoglobulin E ◽

Specific Immunoglobulin ◽

Cow’S Milk Protein

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Clinical phenotypes of childhood food allergies based on immune mechanisms: A multicenter study

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210005 ◽

2021 ◽

Vol 42 (3) ◽

pp. e86-e95 ◽

Cited By ~ 1

Author(s):

Aysen Bingol ◽

Dilara Fatma Kocacik Uygun ◽

Meltem Akdemir ◽

Hakan Erengin ◽

Betul Buyuktiryaki ◽

...

Keyword(s):

Multicenter Study ◽

Immunoglobulin E ◽

Population Characteristics ◽

Health Concern ◽

Food Allergies ◽

Cow’S Milk ◽

Cow's Milk ◽

Tree Nuts ◽

Immune Mechanisms ◽

Ige Mediated

Background: Food allergies (FA) are an important public health concern that place a major burden on the lives of children and their families. The complex pathogenesis of FAs results in multisystemic and heterogenous clinical presentations. Objective: To evaluate, according to immune mechanisms, the characteristics and risk factors of childhood FA in Turkey. Methods: This descriptive multicenter study included 1248 children with FA, aged < 18 years,, who were evaluated by pediatric allergists in 26 different centers. Results: Immune mechanisms of FA were immunoglobulin E (IgE) mediated in 71.8%, non‐IgE mediated in 15.5%, and mixed IgE/non‐IgE mediated in 12.7% of the patients. An episode of anaphylaxis had occurred in 17.6% of IgE-mediated FA. The most common food allergens were classified into five categories (in order of decreasing frequency): cow's milk, egg, tree nuts and/or peanut, wheat, and seafood. Allergies to cow's milk and egg declined significantly with age, whereas tree nuts and/or peanut allergies increased with age. The 0‐2 year age group accounted for 62.5% of the cases. The most frequent cause of FA and food anaphylaxis was cow's milk before age 13 years and tree nuts and/or peanut during adolescence (ages 13‐18 years). Compared with other phenotypes, male sex (odds ratio [OR] 1.486; p = 0.032), sibling(s) (OR 1.581; p = 0.021), and maternal atopy (OR 1.531; p = 0.045) increased the likelihood of IgE-mediated FA, whereas high household income (OR 1.862; p = 0.026) increased the likelihood of non‐IgE-mediated FA in multivariate regression analysis. Conclusion: This study showed that the clinical findings of FA were highly variable, depending on age and underlying immune mechanism. Knowing the population characteristics will enable better management of FA in children.

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