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Lachover-Roth I, Giorno N, Hornik-Lurie T, Cohen-Engler A, Rosman Y, Meir-Shafrir K, Confino-Cohen R. Cow's milk allergy skin tests: fresh milk, commercial extracts, or both? Allergy Asthma Clin Immunol 2023; 19:6. [PMID: 36653849 PMCID: PMC9847062 DOI: 10.1186/s13223-023-00763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The diagnosis of food allergy is based on a history of immediate allergic reaction following food ingestion, and skin prick test (SPT) demonstrating sensitization with commercial extracts (CE) or fresh food (FF). For most food allergens, the SPT with FF is considered more accurate and predictive. Regarding cow's milk, the results are inconclusive. This retrospective study aimed to evaluate the accuracy of SPT with fresh milk compared to CE (cow's milk and casein) for evaluation of cow's milk allergy (CMA). METHODS This study summarized the medical records of children, diagnosed with CMA. The data include demographics, skin tests and oral food challenge results, as well as atopic comorbidities. RESULTS Records of 698 patients with the diagnosis of CMA were reviewed, 388 fulfilled the inclusion criteria. Overall, 134 patients (34.54%) had an additional atopic disease. The SPT wheal size with fresh milk was significantly larger than with CE (cow's milk and casein) at first evaluation or before oral food challenge (OFC). Combination of SPT results (CE and FF) gave the maximal odds ratio for reaction during OFC and SPT with fresh milk alone gave the minimal OR (34.18 and 4.74, respectively). CONCLUSIONS SPT with CE for CMA evaluation is more reliable than SPT performed with fresh milk. In patients suspected of having IgE-mediated CMA, before deciding on performing OFC, it is advised to perform SPT with at least two different extracts, and always include casein. Fresh milk can serve as a backup if commercial extracts are not available. In cases that the SPT with fresh milk is 3 mm or less, there is 93.3% chance that the OFC will pass without reaction. Trial registration This study protocol was reviewed and approved by the Ethics Committee of Meir Medical Center, IRB Number 0083-18 MMC.
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Affiliation(s)
- Idit Lachover-Roth
- grid.415250.70000 0001 0325 0791Allergy and Clinical Immunology Unit, Meir Medical Center, 44261 Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Giorno
- grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Anat Cohen-Engler
- grid.415250.70000 0001 0325 0791Allergy and Clinical Immunology Unit, Meir Medical Center, 44261 Kfar Saba, Israel
| | - Yossi Rosman
- grid.415250.70000 0001 0325 0791Allergy and Clinical Immunology Unit, Meir Medical Center, 44261 Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Meir-Shafrir
- grid.415250.70000 0001 0325 0791Allergy and Clinical Immunology Unit, Meir Medical Center, 44261 Kfar Saba, Israel
| | - Ronit Confino-Cohen
- grid.415250.70000 0001 0325 0791Allergy and Clinical Immunology Unit, Meir Medical Center, 44261 Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Prick-by-Prick Test with Pasteurised Cow’s Milk: A Valuable Tool in Paediatric Practice. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9738654. [PMID: 36119935 PMCID: PMC9473871 DOI: 10.1155/2022/9738654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
Background This study assessed the utility of a prick-by-prick test with pasteurised cow's milk in predicting a pasteurised cow's milk allergy (CMA) diagnosis. Methods This was a retrospective study of 86 paediatric patients who had undergone open pasteurised cow's milk oral food challenges (OFCs). We evaluated the diagnostic performance of a prick-by-prick test with pasteurised cow's milk in predicting a positive OFC result. We calculated the threshold values representing high test specificity and predictive probability in children aged ≤24 and >24 months. Results A prick-by-prick test with pasteurised cow's milk was a good classifier of a positive cow's milk OFC outcome. The mean prick − by − prick test wheal diameter ≥ 3 mm yielded 100% sensitivity in both groups of children. Thresholds representing high test specificity and 95% predicted probability were 7 and 11 mm in children ≤ 24 months and 11 and 17 mm in children > 24 months of age, respectively. Conclusion A prick-by-prick test with pasteurised cow's milk is valuable in paediatric practice when diagnostic thresholds are implemented.
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The Accuracy of Diagnostic Testing in Determining Tree Nut Allergy: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2028-2049.e2. [DOI: 10.1016/j.jaip.2020.12.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
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Cow's Milk Protein Allergy as a Model of Food Allergies. Nutrients 2021; 13:nu13051525. [PMID: 33946553 PMCID: PMC8147250 DOI: 10.3390/nu13051525] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies in infants, and its prevalence has increased over recent years. In the present paper, we focus on CMA as a model of food allergies in children. Understanding the diagnostic features of CMA is essential in order to manage patients with this disorder, guide the use of an elimination diet, and find the best moment to start an oral food challenge (OFC) and liberalize the diet. To date, no shared tolerance markers for the diagnosis of food allergy have been identified, and OFC remains the gold standard. Recently, oral immunotherapy (OIT) has emerged as a new therapeutic strategy and has changed the natural history of CMA. Before this, patients had to strictly avoid the food allergen, resulting in a decline in quality of life and subsequent nutritional, social, and psychological impairments. Thanks to the introduction of OIT, the passive approach involving rigid exclusion has changed to a proactive one. Both the heterogeneity in the diagnostic process among the studies and the variability of OIT data limit the comprehension of the real epidemiology of CMA, and, consequentially, its natural history. Therefore, well-planned randomized controlled trials are needed to standardize CMA diagnosis, prevention, and treatment strategies.
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Uncuoglu A, Eser Simsek I, Cogurlu MT, Baydemir C, Aydogan M. Utility of fresh egg skin prick test and egg yolk specific immunoglobulin E for outgrowth. Ann Allergy Asthma Immunol 2020; 125:418-424. [PMID: 32526376 DOI: 10.1016/j.anai.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In children younger than 2 years, studies evaluating the value of skin prick tests (SPTs) and specific immunoglobulin E (sIgE) results to predict persistence or resolution of egg allergy (EA) are limited. In addition, the value of egg yolk (EY) sIgE and fresh egg (FE) SPTs has not been well characterized. OBJECTIVE To investigate the optimal decision points (ODPs) for outgrowing allergy with SPTs and sIgE tests for egg allergen preparations. METHODS SPTs for FE, egg white (EW), and EY, sIgE tests for EW and EY, and oral food challenges (OFCs) were performed in children with suspected EA. Reactive patients strictly avoided all dietary egg. After 1 year, EA was reevaluated with addition OFCs, SPTs, and sIgE tests. RESULTS A total of 81 children (median age, 7 months; age range, 2-24 months) were enrolled. Notably, 4 children with a history of anaphylaxis and 60 of 77 children with a positive challenge result underwent egg elimination. The 1-year follow-up OFC test was performed on 59 children. A total of 27 reacted to egg. No persistent patient had a follow-up SPT result for FE of 4 mm or less (positive predictive values of 100% and negative predictive value of 56% for outgrowth). The diameters of the initial SPT for FE decreased 50% or more in half of the patients who outgrew EA. The ODPs for outgrowing allergy for follow-up sIgE tests for EY and EW were 2.1 kU/L or less (positive predictive value of 86.2%) and 4.0 kU/L or less (positive predictive value of 84.6%), respectively. CONCLUSION A SPT diameter for FE of 4 mm or less and sIgE values of 2.1 kU/L or less for EY and 4.0 kU/L or less for EW have a good positive predictive value for outgrowth of EA in children younger than 2 years.
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Affiliation(s)
- Aysen Uncuoglu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Isıl Eser Simsek
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mujde Tuba Cogurlu
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Canan Baydemir
- Department of Biostatistics and Medical Informatics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Metin Aydogan
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
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Uncuoglu A, Cogurlu MT, Eser Simsek I, Ergul N, Baydemir C, Aydogan M. Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age. Allergol Immunopathol (Madr) 2019; 47:449-456. [PMID: 30745248 DOI: 10.1016/j.aller.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/09/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old. METHODS SPTs for CE and FM, tests for sIgEs (cow's milk, casein, α-lactoalbumin, β-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis. RESULTS Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7mm, 9mm, and 10.5kU/L, respectively; these values remained higher with ODPfo of 4mm, 11mm, and 10.5kU/L at the last OFC. CONCLUSION Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5kU/L and initial SPT for fresh milk <9mm are related to the acquisition of tolerance in the follow-up period.
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Affiliation(s)
- A Uncuoglu
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Kocaeli University Faculty of Medicine, Turkey
| | - M T Cogurlu
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Turkey
| | - I Eser Simsek
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Turkey
| | - N Ergul
- Department of Pediatrics, Kocaeli University Faculty of Medicine, Turkey
| | - C Baydemir
- Biostatistics and Medical Informatics Department, Kocaeli University Faculty of Medicine, Turkey
| | - M Aydogan
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Turkey.
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Linhart B, Freidl R, Elisyutina O, Khaitov M, Karaulov A, Valenta R. Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy. Nutrients 2019; 11:E1492. [PMID: 31261965 PMCID: PMC6683018 DOI: 10.3390/nu11071492] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open
Abstract
Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.
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Affiliation(s)
- Birgit Linhart
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria.
| | - Raphaela Freidl
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Elisyutina
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
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Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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9
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Franco JM, Pinheiro APSG, Vieira SCF, Barreto ÍDC, Gurgel RQ, Cocco RR, Solé D. Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy. J Pediatr (Rio J) 2018; 94:279-285. [PMID: 28963879 DOI: 10.1016/j.jped.2017.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare serum concentrations of specific IgE and mean papule diameters induced in the immediate skin reactivity test with cow's milk and its fractions with results of the oral challenge test, and to establish cutoff points capable of predicting clinical reactivity to cow's milk in patients treated at a referral service. METHODS One hundred and twenty-two children (median of 17 months) with a history of immediate reactions to cow's milk and presence of specific IgE for cow's milk and/or its fractions (positive skin and/or IgE serum tests) were submitted to open oral challenge test with cow's milk. RESULTS The oral challenge test was positive in 59.8% of the children, 49% of whom were males. Serum levels of specific IgE, as well as mean cow's milk 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 cow's milk and its fractions capable of predicting cow's milk reactivity (positive oral challenge test) were: 5.17kUA/L for cow's milk, 0.95kUA/L for α-lactalbumin, 0.82kUA/L for β-lactoglobulin, and 0.72kUA/L for casein, whereas for papule diameters the cutoff points were 3.5mm for cow's milk and 6.5mm, 9.0mm, and 3.0mm for the α-lactalbumin, β-lactoglobulin, and casein fractions, respectively. CONCLUSIONS The cutoff points capable of predicting clinical reactivity to cow's milk were: 5.17kUA/L for serum-specific IgE and 3.5mm for papule diameter measurement, values considered discriminatory for the diagnosis of cow's milk allergy.
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Affiliation(s)
- Jackeline M Franco
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil; Universidade Federal de Sergipe (UFS), Hospital Universitário, Núcleo de Alergia Alimentar, Aracaju, SE, Brazil.
| | | | - Sarah C F Vieira
- Universidade Federal de Sergipe (UFS), Hospital Universitário, Aracaju, SE, Brazil
| | | | - Ricardo Q Gurgel
- Universidade Federal de Sergipe (UFS), Departamento de Medicina, Disciplina de Pediatria, Aracaju, SE, Brazil
| | - Renata R Cocco
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Pediatria, Disciplina de Alergia, São Paulo, SP, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Pediatria, Disciplina de Alergia, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Pediatria, Disciplina de Imunologia Clínica, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Reumatologia, São Paulo, SP, Brazil
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Pham MN, Wang J. Mammalian milk allergy: case presentation and review of prevalence, diagnosis, and treatment. Ann Allergy Asthma Immunol 2017; 118:406-410. [PMID: 28390582 DOI: 10.1016/j.anai.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Ngoc Pham
- Division of Allergy and Immunology, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine, Mount Sinai, New York, New York.
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11
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Uncuoglu A, Yologlu N, Simsek I, Uyan Z, Aydogan M. Tolerance to baked and fermented cow's milk in children with IgE-mediated and non-IgE-mediated cow's milk allergy in patients under two years of age. Allergol Immunopathol (Madr) 2017; 45:560-566. [PMID: 28720381 DOI: 10.1016/j.aller.2017.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND IgE-mediated cow's milk allergy (CMA) has been shown consistent in milder heated-milk tolerant and severe heated-milk reactant groups in patients older than two years. Little is known whether fermentation of milk gives rise to similar clinical phenotypes. We aimed to determine the influence of extensively heated and fermented cow's milk on the IgE-mediated and non-IgE-mediated CMA in children younger than two years. METHODS Subjects followed with the diagnosis of IgE-mediated and non-IgE-mediated CMA for at least six months underwent unheated milk challenge. IgE-mediated and non-IgE-mediated groups were categorised as unheated milk-reactive and tolerant, separately. Unheated milk-reactive groups were further challenged sequentially with fermented milk (yoghurt) and baked milk, 15 days apart. Allergy evaluation with skin tests, prick-to-prick tests and atopy patch tests were performed. RESULTS Fifty-seven children (median age: 14 months; range: 7-24 months) underwent unheated milk challenge. Eleven of 27 children with IgE-mediated CMA and 14 of 30 children with non-IgE-mediated CMA tolerated unheated milk. Among subjects who reacted to unheated milk; 15 of 16 subjects (93%) with IgE-mediated CMA also reacted to yoghurt, whereas 11 of 16 subjects (68%) with non-IgE-mediated CMA tolerated fermented milk. Thirteen subjects (81%) of the unheated milk-reactive IgE-mediated group tolerated to heated milk. None of 16 subjects of unheated milk-reactive non-IgE-mediated group reacted to baked milk. CONCLUSION The majority of children under the age of two years with both IgE-mediated and non-IgE-mediated CMA tolerated baked-milk products. Yoghurt was tolerated in two thirds of unheated milk reactive patients suffering from non-IgE-mediated CMA.
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Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, La Grutta S, Panetta V, Verga MC, Calvani M. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review. Ital J Pediatr 2017; 43:93. [PMID: 29025431 PMCID: PMC5639767 DOI: 10.1186/s13052-017-0410-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of IgE-mediated cow's milk allergy is often based on anamnesis, and on specific IgE (sIgE) levels and/or Skin Prick Tests (SPT), which have both a good sensitivity but a low specificity, often causing positive results in non-allergic subjects. Thus, oral food challenge is still the gold standard test for diagnosis, though being expensive, time-consuming and possibly at risk for severe allergic reactions. AIM The aim of the present study was to perform a systematic review of the studies that have so far analyzed the positive predictive values for sIgE and SPT in the diagnosis of allergy to fresh and baked cow's milk according to age, and to identify possible cut-offs that may be useful in clinical practice. METHODS A comprehensive search on Medline via PubMed and Scopus was performed August 2017. Studies were included if they investigated possible sIgE and/or SPT cut-off values for cow's milk allergy diagnosis in pediatric patients. The quality of the studies was evaluated according to QUADAS-2 criteria. RESULTS The search produced 471 results on Scopus, and 2233 on PubMed. Thirty-one papers were included in the review and grouped according to patients' age, allergen type and cooking degree of the milk used for the oral food challenge. In children < 2 years, CMA diagnosis seems to be highly likely when sIgE to CM extract are ≥ 5 KUA/L or when SPT with commercial extract are above 6 mm or Prick by Prick (PbP) with fresh cow's milk are above 8 mm. Any cut-offs are proposed for single cow's milk proteins and for baked milk allergy in children younger than 2 years. In Children ≥ 2 years of age it is hard to define practical cut-offs for allergy to fresh and baked cow's milk. Cut-offs identified are heterogeneous. CONCLUSIONS None of the cut-offs proposed in the literature can be used to definitely confirm cow's milk allergy diagnosis, either to fresh pasteurized or to baked milk. However, in children < 2 years, cut-offs for specific IgE or SPT seem to be more homogeneous and may be proposed.
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Affiliation(s)
- Barbara Cuomo
- Operative Complex Unit of Pediatrics, Belcolle Hospital, Viterbo, Italy.
| | - Giovanni Cosimo Indirli
- Operative Unit of PediatricAllergy, San Giuseppe da Copertino Hospital, Copertino, LE, Italy
| | - Annamaria Bianchi
- Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Stefania Arasi
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Davide Caimmi
- Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, France.,Sorbonnes Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, F-75013, Paris, France
| | - Arianna Dondi
- Department of Pediatric Emergency, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council, 90100, Palermo, Italy
| | - Valentina Panetta
- L'altrastatisticasrl, Consultancy & Training, Biostatistics office, Rome, Italy
| | | | - Mauro Calvani
- Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
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Comparison of results and clinical value of skin prick tests with synthetic and native food allergens in patients at the age of up to 3 years. Postepy Dermatol Alergol 2016; 33:485-487. [PMID: 28035229 PMCID: PMC5183788 DOI: 10.5114/ada.2016.63889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/20/2016] [Indexed: 11/17/2022] Open
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Neves FVDO, Beck CDML, Gushken AKF, Yonamine GH, Castro APBM, Dorna MDB, Santos CDJND, Pastorino AC. Cow's milk allergy: Evaluating tolerance through skin-prick test. Rev Assoc Med Bras (1992) 2016; 62:537-543. [PMID: 27849231 DOI: 10.1590/1806-9282.62.06.537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Flavia Valença de Oliveira Neves
- MSc from Faculdade de Medicina, Universidade de São Paulo (FMUSP). Unit of Allergy and Immunology, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
| | - Cleonir de Moraes Lui Beck
- MSc from Faculdade de Medicina, Universidade de São Paulo (FMUSP). Unit of Allergy and Immunology, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
| | - Andrea Keiko Fujinami Gushken
- MSc from Faculdade de Medicina, Universidade de São Paulo (FMUSP). Unit of Allergy and Immunology, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
| | - Glauce Hiromi Yonamine
- MSc from FMUSP. Division of Nutrition, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil
| | | | - Mayra de Barros Dorna
- MSc from Faculdade de Medicina, Universidade de São Paulo (FMUSP). Unit of Allergy and Immunology, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
| | | | - Antonio Carlos Pastorino
- MSc and PhD in Sciences from FMUSP. Head of the Unit of Allergy and Immunology, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
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15
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Kido J, Hirata M, Ueno H, Nishi N, Mochinaga M, Ueno Y, Yanai M, Johno M, Matsumoto T. Evaluation of the skin-prick test for predicting the outgrowth of cow's milk allergy. ALLERGY & RHINOLOGY 2016; 7:139-143. [PMID: 28107145 PMCID: PMC5244269 DOI: 10.2500/ar.2016.7.0175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Although considerable efforts have been made to develop diagnostic tools for predicting the outcome of oral food challenges, tests for predicting the outgrowth of food allergies are lacking. Objective: The aim of this study was to assess the diagnostic value of the wheal size and skin index (SI) (the ratio of an allergen-induced wheal to a histamine-induced wheal diameter) of the skin-prick test based on the outcome of a controlled oral provocation test for cow's milk. Moreover, we assessed whether wheal size and/or SI were useful for predicting the outgrowth of cow's milk allergy (CMA). Methods: This study included 135 children with suspected CMA. Eighty-one patients were definitely diagnosed by oral provocation tests for cow's milk, and their wheal diameters, SIs, and cow milk's–specific serum immunoglobulin E concentrations were determined. Results: The wheal diameters were significantly larger and the SIs significantly higher in children with positive oral provocation test results than in those with negative test results. We found that 50% of the patients were expected to be able to drink cow's milk by age 5 years. In these patients, the wheal diameters were significantly smaller and the SIs significantly lower at the time of CMA outgrowth than at the time of diagnosis, whereas these values were apt to increase in patients who did not outgrow CMA, with no significant difference. Conclusions: The skin-prick test can be used to diagnose CMA and predict CMA outgrowth. A wheal diameter of 8 mm or/and an SI of 1.0 is informative, not only in diagnosing CMA but also in predicting a natural CMA outgrowth.
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Affiliation(s)
- Jun Kido
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
| | - Megumi Hirata
- Department of Child Development, Kumamoto University Hospital, Kumamoto City, Kumamoto, Japan
- Pediatric Division, Tamana Central Hospital, Tamana City, Kumamoto, Japan
| | - Hiroe Ueno
- Department of Child Development, Kumamoto University Hospital, Kumamoto City, Kumamoto, Japan
- Pediatric Division, Kumamoto Saishunso National Hospital, Kohshi City, Kumamoto, Japan
| | - Natsuko Nishi
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
| | - Masaho Mochinaga
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
| | - Yasushi Ueno
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
| | - Masaaki Yanai
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
| | - Masayoshi Johno
- Division of Dermatology, Kumamoto Shinto General Hospital, Kumamoto, City, Kumamoto, Japan, and
| | - Tomoaki Matsumoto
- From the Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto City, Kumamoto, Japan
- Department of Child Development, Kumamoto University Hospital, Kumamoto City, Kumamoto, Japan
- Pediatric Division, Aso Spa Hospital, Aso City, Kumamoto, Japan
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16
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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17
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Martorell-Aragonés A, Echeverría-Zudaire L, Alonso-Lebrero E, Boné-Calvo J, Martín-Muñoz M, Nevot-Falcó S, Piquer-Gibert M, Valdesoiro-Navarrete L. Position document: IgE-mediated cow's milk allergy. Allergol Immunopathol (Madr) 2015; 43:507-26. [PMID: 25800671 DOI: 10.1016/j.aller.2015.01.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 01/17/2023]
Abstract
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 from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.
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18
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Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT. BSACI guideline for the diagnosis and management of cow's milk allergy. Clin Exp Allergy 2014; 44:642-72. [PMID: 24588904 DOI: 10.1111/cea.12302] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/19/2014] [Accepted: 02/26/2014] [Indexed: 12/20/2022]
Abstract
This guideline advises on the management of patients with cow's milk allergy. Cow's milk allergy presents in the first year of life with estimated population prevalence between 2% and 3%. The clinical manifestations of cow's milk allergy are very variable in type and severity making it the most difficult food allergy to diagnose. A careful age- and disease-specific history with relevant allergy tests including detection of milk-specific IgE (by skin prick test or serum assay), diagnostic elimination diet, and oral challenge will aid in diagnosis in most cases. Treatment is advice on cow's milk avoidance and suitable substitute milks. Cow's milk allergy often resolves. Reintroduction can be achieved by the graded exposure, either at home or supervised in hospital depending on severity, using a milk ladder. Where cow's milk allergy persists, novel treatment options may include oral tolerance induction, although most authors do not currently recommend it for routine clinical practice. Cow's milk allergy must be distinguished from primary lactose intolerance. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for clinicians in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking the panel of experts in the committee reached consensus. Grades of recommendation are shown throughout. The document encompasses epidemiology, natural history, clinical presentations, diagnosis, and treatment.
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Affiliation(s)
- D Luyt
- University Hospitals of Leicester NHS Trust, Leicester, UK
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19
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Payot F, Berthiller J, Kassai B, Brunet AS, Villard-Truc F, Lachaux A. Practical interest of both skin prick test and specific IgE in the evaluation of tolerance acquisition in IgE mediated cow's milk allergy (CMA). A clinical retrospective study in a cohort of 184 children. Allergol Immunopathol (Madr) 2014; 42:395-401. [PMID: 23791508 DOI: 10.1016/j.aller.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cow's milk protein allergy (CMPA) represents one of the leading causes of food allergy in infants and young children. The immune reaction may be IgE mediated, non-IgE mediated, or mixed. IgE-mediated cow's milk protein allergy is revealed by immediate and acute symptoms which can be severe. The aim of this study is to report a one centre experience in the real life of testing children with IgE-mediated CMPA and try to identify predictive factor for follow-up challenges. METHOD Retrospective and monocentric study between September 1997 and February 2008. 178 infants diagnosed with IgE-mediated CMPA during breastfeeding weaning were included. Initial factors such as age, sex, skin prick tests (SPTs), specific IgE (sIgE), atopic dermatitis and types of reaction were noted. Between 12 and 24 months all infants have undergone at least one evaluation including SPT. RESULTS At the food challenge, 138 (75.8%) infants were found tolerant. Results of the skin prick test (SPT) were statistically different according to the food challenge result (2.2mm vs. 5.1mm, p<0.0001). It was the same result for sIgE for CM 2.0ku/l vs. 11.5ku/l - p<0.0001 and for casein 1.0ku/l vs. 16.0ku/l - p=0.0014. CONCLUSION This study confirms the practical interest of both SPT and sIgE in the evaluation of tolerance induction in IgE-mediated CMPA, but with no corresponding results. Sensitivity, specificity and probability curves of success for cow's milk challenge can be determined and have clinical utility.
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Affiliation(s)
- F Payot
- Hospices Civils de Lyon, Lyon 1 University, Allergology Unit, Department of Pediatrics, HFME Children's Hospital of Lyon, CHU de Lyon, 59 bvd Pinel, 69677 Bron, France
| | - J Berthiller
- Hôpital Louis Pradel, EPICIME-INSERM CIC201, 28, Avenue du Doyen Lépine, 69677 cedex, Bron, France; Université Lyon 1, Equipe d'Accueil 4129, France; CHU Lyon, Service de Pharmacologie Clinique, 8 rue Guillaume Paradin, BP8071, 69376 cedex 08, Lyon, France.
| | - B Kassai
- CHU Lyon, Service de Pharmacologie Clinique, 8 rue Guillaume Paradin, BP8071, 69376 cedex 08, Lyon, France; University of Lyon 1, CRNS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive Lyon, 8 rue Guillaume Paradin, BP8071, 69376 cedex 08, Lyon, France
| | - A-S Brunet
- Hospices Civils de Lyon, Lyon 1 University, Allergology Unit, Department of Pediatrics, HFME Children's Hospital of Lyon, CHU de Lyon, 59 bvd Pinel, 69677 Bron, France
| | - F Villard-Truc
- Hospices Civils de Lyon, Lyon 1 University, Allergology Unit, Department of Pediatrics, HFME Children's Hospital of Lyon, CHU de Lyon, 59 bvd Pinel, 69677 Bron, France
| | - A Lachaux
- Hospices Civils de Lyon, Lyon 1 University, Allergology Unit, Department of Pediatrics, HFME Children's Hospital of Lyon, CHU de Lyon, 59 bvd Pinel, 69677 Bron, France
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20
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Imai T, Yanagida N, Ogata M, Komata T, Tomikawa M, Ebisawa M. The skin prick test is not useful in the diagnosis of the immediate type food allergy tolerance acquisition. Allergol Int 2014; 63:205-10. [PMID: 24561767 DOI: 10.2332/allergolint.12-oa-0513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/10/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Some studies have been reported about positioning of SPT in the diagnosis of food allergy. On the other hand, it is not yet clear about the positioning of SPT in the diagnosis of tolerance acquisition of the immediate type food allergy. METHODS The retrospective study had been conducted for 236 egg allergic children (51.3 months in mean), 127 milk allergic children (53.4 months), and 96 wheat allergic children (42.6 months). The retrospective analysis of serum nonspecific and antigen-specific IgE levels, SPT, and OFC had been conducted for each allergic patient. All OFC had been conducted to verify the acquisition of tolerance against eliminated food. RESULTS The OFC was positive in 61 (25.8%) hen's egg allergies, 34 (26.8%) milk allergies and 33 (34.4%) wheat allergies. The greatest AUC for each allergen is as following; hen's egg for egg white specific IgE at 0.745, milk/histamine (wheal) index at 0.718, and wheat for wheal size at 0.597. For the predictive decision points, the highest accuracy rate was at 25.8% for an egg white wheal of 9.5mm, at 26.8% for a milk wheal of 9.5mm, and at 34.4% for a wheal of 6.5mm. CONCLUSIONS As a result of this analysis, the diagnostic accuracy of SPT had not been satisfactory to judge the acquisition of tolerance in allergic children for eggs, milk and wheat. Therefore, this is not a strong evidence to testify the tolerance of the immediate type food allergy.
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Affiliation(s)
- Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan; Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Mika Ogata
- Department of Pediatrics, National Hospital Organization, National Kumamoto Medical Center, Kumamoto, Japan
| | - Takatsugu Komata
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Morimitsu Tomikawa
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
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21
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Cingolani A, Di Pillo S, Cerasa M, Rapino D, Consilvio NP, Attanasi M, Scaparrotta A, Marcovecchio ML, Mohn A, Chiarelli F. Usefulness of nBos d 4, 5 and nBos d 8 Specific IgE Antibodies in Cow's Milk Allergic Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 6:121-5. [PMID: 24587947 PMCID: PMC3936039 DOI: 10.4168/aair.2014.6.2.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/13/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of study was to assess the value of recombinants in predicting the degree of symptoms in children with and without anaphylaxis to cow's milk. METHODS The study included 79 children (70±40 months) referred to the Allergological Unit of the Pediatric Department between the years 2008-2012. Group A was composed of 17 children (78±49.6 months) with anaphylaxis after ingestion of milk. Group B was composed of 62 children (73.1±38.6 months) without a history of anaphylaxis, but with less severe symptoms (gastrointestinal and/or skin symptoms). All patients from Group B had a positive open challenge with cow's milk. All patients underwent an allergic evaluation and blood samples were collected to test for IgE to recombinans of milk (nBos d 4, 5, 8). RESULTS A significant difference in nBos d 8 emerged with higher levels in Group A (median [IQR]=2.80 [0.91-16.1]) than B (0.65 [0.24-1.67]; P=0.006), whereas there were no statistically significant differences for nBos d 4 and 5. The recombinants' sum was higher in Group A than B: 8.39 [2.72-41.39] vs 3.04 [1.85-7.31] kUA/L; P=0.044. The recombinant nBos d 8 was superior to the other recombinants in identifying children at risk for anaphylaxis, with an area under the curve of 0.718 (95% CI, 0.57-0.86, P=0.006). Considering a cutoff of 1.8 kUA/L, nBos d 8 had the most favorable sensitivity and specificity ratio (sensitivity=0.65, specificity=0.77) with an odd ratio of 6.02 (95% C.I: 1.89-19.23). CONCLUSIONS This study suggested 2 phenotypes of allergic children, "high-anaphylaxis-risk" and "milder-risk". These types can be differentiated through measuring the level of IgE to nBos d 8.
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Affiliation(s)
- Anna Cingolani
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Marzia Cerasa
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Daniele Rapino
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Marina Attanasi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | | | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Chieti, Italy
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Abstract
Food allergy is a growing worldwide epidemic that adversely effects up to 10% of the population. Causes and risk factors remain unclear and diagnostic methods are imprecise. There is currently no accepted treatment for food allergy. Therefore, there is an imminent need for greater understanding of food allergies, revised diagnostics and development of safe, effective therapies. Oral immunotherapy provides a particularly promising avenue, but is still highly experimental and not ready for clinical use.
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Affiliation(s)
- Aleena Syed
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Arunima Kohli
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kari C Nadeau
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Hochwallner H, Schulmeister U, Swoboda I, Spitzauer S, Valenta R. Cow's milk allergy: from allergens to new forms of diagnosis, therapy and prevention. Methods 2013; 66:22-33. [PMID: 23954566 PMCID: PMC3969108 DOI: 10.1016/j.ymeth.2013.08.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 12/22/2022] Open
Abstract
The first adverse reactions to cow's milk were already described 2,000 years ago. However, it was only 50 years ago that several groups started with the analysis of cow's milk allergens. Meanwhile the spectrum of allergy eliciting proteins within cow's milk is identified and several cow's milk allergens have been characterized regarding their biochemical properties, fold and IgE binding epitopes. The diagnosis of cow's milk allergy is diverse ranging from fast and cheap in vitro assays to elaborate in vivo assays. Considerable effort was spent to improve the diagnosis from an extract-based into a component resolved concept. There is still no suitable therapy available against cow's milk allergy except avoidance. Therefore research needs to focus on the development of suitable and safe immunotherapies that do not elicit severe side effect.
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Affiliation(s)
- Heidrun Hochwallner
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria.
| | - Ulrike Schulmeister
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Ines Swoboda
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
| | - Susanne Spitzauer
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
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24
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Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol 2013. [PMID: 23195525 DOI: 10.1016/j.jaci.2012.10.017] [Citation(s) in RCA: 490] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Calvani M, Berti I, Fiocchi A, Galli E, Giorgio V, Martelli A, Miceli Sopo S, Panetta V. Oral food challenge: safety, adherence to guidelines and predictive value of skin prick testing. Pediatr Allergy Immunol 2012; 23:755-61. [PMID: 23106528 DOI: 10.1111/pai.12016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnostic gold standard of food allergy is the oral food challenge (OFC). Data on severe reactions and drug use during OFC are scarce. Our aims were (i) to investigate the prevalence and spectrum of reactions' severity during OFC and to assess drug use and epinephrine use in anaphylaxis due to OFC; (ii) to investigate the predictive value of the skin prick test wheal size for the outcome of OFCs. METHODS A retrospective charts review of children undergoing OFC at three Allergy Centres between January 2007 and December 2008 was performed. RESULTS A total of 544 OFCs were analysed. Most frequently involved foods were egg, milk and wheat. 254/526 (48.3%) were positive. 167 (65.7%) were defined mild reactions, 81 (31.9%) multiorgan reactions and 6 (2.4%) anaphylaxis. No patients had cardiovascular symptoms. Data on treatments were available in 98.8% OFCs. In half of them antihistamines were used vs. 10% cases in which steroids were preferred. Six children (2.4%) were treated with Epinephrine inhalation, 5 (2%) with beta-2 inhalation, 8 (3.1%) with steroid inhalation. One child was treated with IM Epinephrine + IV fluids. Skin prick tests predictive cut-off were 9 mm for albumen, 7 for yolk, 13 for fresh albumen, 10 for α-lactalbumin, seven for casein, eight for β-lactoglobulin, 20 for cow's milk and 10 for fresh cow's milk. CONCLUSION OFCs performed in controlled settings by expert Allergists are safe. Consideration needs to be given as to whether the Anaphylaxis' Guideline need to be modified when applied in treating patients undergoing OFC.
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Affiliation(s)
- Mauro Calvani
- Department of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
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26
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Bellini F, Ricci G, Dondi A, Piccinno V, Angelini F, Pession A. End point prick test: could this new test be used to predict the outcome of oral food challenge in children with cow's milk allergy? Ital J Pediatr 2011; 37:52. [PMID: 22053846 PMCID: PMC3220633 DOI: 10.1186/1824-7288-37-52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 11/04/2011] [Indexed: 11/10/2022] Open
Abstract
Background Cow's milk allergy (CMA) is the most frequent food allergy in childhood; the trend of CMA is often characterized by a progressive improvement to achieve tolerance in the first 4 to 5 years of life. It has been observed that specific IgE (sIgE) towards cow's milk proteins decrease when the age increases. Although food allergy can be easily diagnosed, it is difficult to predict the outcome of the oral food challenge (OFC), that remains the gold standard in the diagnosis of food allergy, by allergometric tests. Methods We considered 44 children with CMA diagnosed through OFC who returned to our Allergy and Immunology Pediatric Department between January to December 2010 to evaluate the persistence of allergy or the achievement of tolerance. On the basis of the history, we performed both allergometric skin tests and OFC in children that were still following a milk-free diet, whereas only allergometric skin tests those that had already undergone spontaneous introduction of milk protein at home without presenting symptoms. Objective The aim of this study was to investigate the relationship between the persistence of CMA or the acquisition of tolerance and the results of the end point prick test (EPT). Results and Discussion The OFC with cow's milk was performed on 30 children, 4 children were excluded because of a history of severe reactions to cow's milk, and 10 because they had spontaneously already taken milk food derivates at home without problems. 16/30 (53%) children showed clinical reactions and the challenge was stopped, 14/30 (47%) did not have any reaction. Comparing the mean wheal diameter of every EPT's dilution between the group of allergic children and the tolerant ones, we obtained a significant difference (p < 0.05) for the first 4 dilutions. We have also calculated sensitivity (SE), specificity (SP), the positive predictive value (PPV) and the negative predictive value (NPV) for each EPT dilution. Conclusions EPT is a safe and cheap test, easy to be executed and that could provide good prediction of the outcome of OFC; so it might be used to avoid OFC-induced anaphylaxis in children affected by CMA. It can also help avoiding dietetic restrictions in tolerant children who show sensitization towards cow's milk proteins.
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Affiliation(s)
- Federica Bellini
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences, University of Bologna, Bologna, Italy
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Abstract
PURPOSE OF REVIEW Food-induced anaphylaxis is the leading single cause of anaphylaxis treated in emergency departments and increasing in prevalence. RECENT FINDINGS Food allergy is an increasing problem in westernized countries around the world, with a cumulative prevalence of 3-6%. Peanut, tree nuts, and shellfish are the most commonly implicated foods in anaphylaxis, although milk is a common trigger in children. Asthmatics, adolescents, and those with a prior reaction are at increased risk for more severe reactions. Most first reactions and reactions in children most commonly occur at home, whereas most subsequent reactions and reactions in adults occur outside home. Studies on schools have identified inadequate management plans and symptom recognition whereas those on restaurants report lack of prior notification by allergic individuals and lack in staff education. Epinephrine, although underutilized is the drug of choice with multiple doses needed in up to one-fifth of reactions. Diagnosis is currently based on convincing history and allergy testing supported by elevated serum tryptase, if available. Long-term management includes strict avoidance and emergency action plan. SUMMARY With a growing population of food-allergic children and adults, markers to predict which individuals are at increased risk for anaphylaxis as well as new therapies are vigorously sought.
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van Bilsen J, Ronsmans S, Crevel R, Rona R, Przyrembel H, Penninks A, Contor L, Houben G. Evaluation of scientific criteria for identifying allergenic foods of public health importance. Regul Toxicol Pharmacol 2011; 60:281-9. [DOI: 10.1016/j.yrtph.2010.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/23/2010] [Accepted: 08/31/2010] [Indexed: 10/19/2022]
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29
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Abstract
Cow's milk allergy (CMA) affects 2% to 3% of young children and presents with a wide range of IgE and non-IgE-mediated clinical syndromes, which have a significant economic and lifestyle effect. It is logical that a review of CMA would be linked to a review of soy allergy because soy formula is often an alternative source of nutrition for infants who do not tolerate cow's milk. This review examines the epidemiology, pathogenesis, clinical features, natural history, and diagnosis of cow's milk and soy allergy. Cross-reactivity and management of milk allergy are also discussed.
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Affiliation(s)
- Jacob D. Kattan
- Clinical Fellow, Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, NY, USA
| | - Renata R. Cocco
- Clinical Researcher, Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Brazil
| | - Kirsi M. Järvinen
- Assistant Professor, Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, NY, USA
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30
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Solinas C, Corpino M, Maccioni R, Pelosi U. Cow's milk protein allergy. J Matern Fetal Neonatal Med 2010; 23 Suppl 3:76-9. [DOI: 10.3109/14767058.2010.512103] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010; 3:57-161. [PMID: 23268426 PMCID: PMC3488907 DOI: 10.1097/wox.0b013e3181defeb9] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Rancé F, Dutau G. Actualités sur l’exploration et la prise en charge de l’allergie aux protéines du lait de vache (APLV). REVUE FRANCAISE D ALLERGOLOGIE 2009. [DOI: 10.1016/s1877-0320(09)72481-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis. Curr Opin Allergy Clin Immunol 2009; 9:251-8. [DOI: 10.1097/aci.0b013e32832b3f33] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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34
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:284-90. [DOI: 10.1097/aci.0b013e32832c00ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Abstract
PURPOSE OF REVIEW To give an update about the optimal diagnostic work-up for children with suspected food allergy. RECENT FINDINGS Food allergy has become a very severe health problem not only for many children and parents, but also for the entire medical and paramedical community. The financial and social costs related to these conditions are increasing, but, contemporarily, basic and clinical research are deeply involved in the search of possible solutions to facilitate the management of these patients. SUMMARY Food allergy is defined as an abnormal immunological reaction to food proteins, which causes an adverse clinical reaction. Over 90% of food allergies in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish and shellfish. The evaluation of a child with suspected food allergy includes detailed medical history, physical examination, screening tests and response to elimination diet and to oral food challenge. None of the screening tests, alone or in combination, can definitely diagnose or exclude it. The main principle of food allergy management is avoidance of the offending antigen. An incorrect diagnosis is likely to result in unnecessary dietary restrictions, which, if prolonged, may adversely affect the child's nutritional status and growth.
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