Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review (original) (raw)
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Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy
Jornal de pediatria, 2017
To compare serum concentrations of specific IgE and mean papule diameters induced in the immediate skin reactivity test with cow's milk (CM) and its fractions with results of the oral challenge test (OCT), and to establish cutoff points capable of predicting clinical reactivity to CM in patients treated at a referral service. One hundred and twenty-two children (median of 17 months) with a history of immediate reactions to CM and presence of specific IgE for CM and/or its fractions (positive skin and/or IgE serum tests) were submitted to open OCT with CM. The OCT was positive in 59.8% of the children, 49% of whom were males. Serum levels of specific IgE, as well as mean CM papule diameters, were significantly higher in allergic patients (medians: 3.39kUA/L vs. 1.16kUA/L, 2.5mm vs. 0mm). The optimal cutoff points (Youden's index) of serum IgE specific for CM and its fractions capable of predicting CM reactivity (positive OCT) were: 5.17kUA/L for CM, 0.95kUA/L for α-lactalbumi...
Assessment of IgE-Mediated and Non-IgE-Mediated Cow’s Milk Protein Allergy in Children
ARS Medica Tomitana, 2019
Cow’s milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth. In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta. The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow’s Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed. We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), ...
Clinical and Translational Allergy, 2017
Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, 'Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide' was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow's milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise.
European annals of allergy and clinical immunology, 2014
Oral food challenge (OFC) is still considered the gold standard for diagnosis of food allergy (FA). Skin prick test (SPT) and specific IgE (sIgE) tests are very useful but limited in their predictive accuracy. End point test (EPT) has been recently considered to determine the starting dose to induce oral desensitization. Allergometric tests combined may discriminate children at higher risk of reactions during OFC. We considered 94 children referred to our Allergy and Immunology Pediatric Department between January 2009 and December 2011 with CMA. Cutaneous allergometric skin tests (SPT and EPT) were periodically performed on all 94 children with CMA; sIgE levels against cow's milk proteins (CMP) α-lactalbumin, β-lactoglobulin and casein were periodically evaluated through blood samples every 6-12 months. During the period of the study, 26/94 (27.6%) children underwent more than once OFC. We collected 135 OFC compared with clinical presentation: 49/135 (36.2%) OFC were performed ...
Iranian Journal of Pediatrics, 2018
Background: The majority of infants and children with cow's milk allergy will grow out of their allergy after a few years. The aim of this study was to identify the natural course of cow's milk allergy in infants and children during a follow-up of 18 months and also the predictive factors for its outgrowing. Methods: This prospective cross-sectional study included infants and children with IgE-mediated cow's milk allergy. Demographic data, clinical manifestations and probable predictive factors were recorded. Skin prick tests were done with commercial extracts of cow's milk, egg, fish, nuts and wheat on arrival. These infants and children were followed for 18 months and resolution was established by successful ingestion of cow's milk. The collected data were analyzed using SPSS version 22.0. Descriptive statistics, student's t-test or Mann-Whitney U-test and Chi-square test were used; a P < 0.05 was considered statistically significant. Results: Forty-nine infants and children (33 boys and 16 girls) with IgE-mediated cow's milk allergy presentation ranged in age from 3.5 to 48 months with a mean of 17.5 ± 11.7 months enrolled in this study. Skin was the most common site of involvement, followed by gastrointestinal system and respiratory tract. Twenty-three (46%) infants and children developed tolerance to cow's milk during a follow-up of 18 months. There was a significant relationship between parental allergy and atopic dermatitis with the chance of tolerance of cow's milk. Conclusions: Our findings showed that about one half of the infants and children with IgE-mediated cow's milk allergy grew out of it over 18 months of follow-up (mean age 2 years). The follow-up of patients with cow's milk allergy is important in appropriate timing of re-introduction of cow's milk to the diet; atopic dermatitis and parental allergy can predict this outcome.
Position document: IgE-mediated cow's milk allergy
Allergologia et immunopathologia, 2015
The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk fr...
IgE sensitisation predicts threshold but not anaphylaxis during oral food challenges to cow's milk
2021
Predicting reaction threshold and severity are important to improve the management of food allergy, however the determinants of, and relationship between, these parameters are significant knowledge gaps. Identifying robust predictors could enable the reliable risk-stratification of food-allergic individuals. In this series of young people with CM-allergy undergoing DBPCFC – the largest reported in the literature – we did identify any baseline marker which predicted the occurrence of anaphylaxis at challenge, consistent with existing data. There is one report of IgE-sensitisation being predictive of severity in CM-allergy, however the authors included non-reactive patients in their analysis which significantly skewed the analyses, resulting in misleading conclusions. IgE-sensitisation in our cohort, particularly to casein, was predictive of LOAEL. Including an assessment of casein IgE may therefore be of clinical utility when evaluating patients with CM-allergy in the clinical setting.
Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins
Annals of Allergy Asthma & Immunology, 2002
Objectives: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs) in pediatric food allergy, focusing on adverse reactions to milk and beef. To present data about the test performance characteristics of beef extracts used in SPTs among children with atopic dermatitis (AD) reporting immediate hypersensitivity to beef.
Allergy, 2013
Atopy patch tests (APTs) have been proposed for the diagnostic approach in children with non-IgE-mediated cow's milk allergy and gastrointestinal symptoms. We aimed to investigate the benefit of APTs in predicting oral tolerance in these patients. We prospectively evaluated 172 subjects with a sure diagnosis of non-IgE-mediated CMA and gastrointestinal symptoms (97 boys, 56.4%; age, 6.37 m; range, 2-12 m). At diagnosis, 113/172 (65.7%) children had positive APTs to cow's milk proteins (CMP). After 12 months of exclusion, diet APTs were repeated immediately before OFC. APTs significantly correlated (P < 0.001) with the OFC outcome (r 0.579). Diagnostic accuracy was sensitivity of 67.95%, specificity of 88.3%, PPV of 82.81%, NPV of 76.85%, and a +LR of 5.80. APTs are a valuable tool in the follow-up of children with non-IgE-mediated CMA-related gastrointestinal symptoms by contributing in determining whether an OFC can safely be undertaken.