Cow's milk‐specific immunoglobulin E levels as predictors of clinical reactivity in the follow‐up of the cow's milk allergy infants

García-Ara, M. C.; Boyano-Martínez, Maria Teresa; Díaz-Pena, José María; Martín-Muñoz, M.F.; Martín-Esteban, Manuel

doi:10.1111/j.1365-2222.2004.01976.x

Cited by 151 publications

(125 citation statements)

References 11 publications

(15 reference statements)

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“…Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs. [5][6][7][8][9][10] However, FSIgE levels are less effective in identifying children who experience a negative OFC. 11 In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%.…”

mentioning

confidence: 99%

Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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Children 2 Oral food challenges (OFCs) are the recommended procedure to document the resolution of food allergy, 3,4 but they are time-consuming, difficult to perform, require resources, and expose the patient to the risk of a significant allergic reaction. Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs.5-10 However, FSIgE levels are less effective in identifying children who experience a negative OFC. 11In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%.3 Previous research 11 has revealed that FSIgE of Յ2 kUa/L (or Յ5 kUa/L for peanuts without a history of previous reaction) are associated with an estimated Յ50% likelihood of reacting to eggs, milk, or peanuts during an OFC, and these FSIgE values have been incorporated into clinical guidelines.11 Identifying additional clinical and laboratory factors associated with negative OFC within this group of patients would improve patient care by decreasing the number of unnecessary (i.e., predictably positive) OFCs.Recently, it was shown that the incorporation of clinical and laboratory data to supplement FSIgE levels effectively diagnosed food allergy and might eliminate the need for some OFCs to confirm the presence of food allergy. 12,13 We extended this approach to the clinical scenario aimed at increasing the accuracy of identifying children who will experience negative OFCs. We aimed to investigate if there are food-specific combinations of clinical and laboratory characteristics that define subgroups of children, undergoing OFC based on the guideline-recommended FSIgE levels, 3 who are most likely to experience a negative OFC.

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mentioning

confidence: 99%

Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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“…In this clinically different population, the sensitivity of the test decreased to 34 % and a better performance was obtained by using a lower decision point of 15 kU/L (57 % sensitivity, 94 % specificity). In a recent prospective study of a group of children with cow's milk allergy, Garcia-Ara et al 10 showed that the sIgE levels, which were predictors of clinical reactivity, increased with age. This suggests that age must also be taken into consideration when establishing sIgE cutoffs.…”

Section: Discussionmentioning

confidence: 99%

In vitro methods for specific IgE detection on cow's milk allergy

Prates

Morais‐Almeida

Matos

et al. 2006

Allergologia et Immunopathologia

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Background: A new method for determining serum specific IgE (IMMULITE " 2000 3gAllergy) has recently become available.Objective: To evaluate the clinical performance of IMMULITE 2000 in the diagnosis of cow's milk allergy compared with that of UniCAP " . Additionally, we verified the behavior of both methods at two diagnostic decision points proposed by other authors.Methods: The study population consisted of 31 children with cow's milk allergy (group A) and a control group of 19 atopic children without food allergy (group B). A blood sample from each child was tested using both methods and the results were compared.Results: In group A, the values for cow's milk IgE ranged from 0.35 kU/L (the lowest common detection limit) to above 100 kU/L. In group B, the values were less than 1.1 kU/L for IMMULITE 2000 and less than 1.6 kU/L for UniCAP . An agreement of 90 % in IgE classes was obtained. Both methods demonstrated exactly the same diagnostic performance (sensitivity: 100 %; specificity: 78.9 %; negative predictive value: 100 %; positive predictive value: 84.6 %; efficiency: 90.2 %). The evaluation of the two methods at the two different decision points proposed in the literature showed a better positive predictive value with UniCAP, but we obtained equivalent performance with IMMULITE 2000 by choosing higher cutoff values.Conclusions: We conclude that IMMULITE 2000 is as effective as UniCAP in the diagnosis of cow's milk allergy. Both methods can be used to obtain site-specific decision points that are population, age and disease dependent.

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“…The incidence of CMA varies with age. CMA is prevalent in early childhood with reported incidences between 2 and 6% [10][11][12] and decreases into adulthood to an incidence of 0.1-0.5% [13][14]. It has been suggested that infants have milk allergies because milk is usually the first source of foreign antigens that they ingest in large quantities, and the infant intestinal system is insufficiently developed to digest and immunologically react to milk proteins.…”

Section: Milk Allergymentioning

confidence: 99%