Predictive Factors for Oral Immune Modulation in Cow Milk Allergy

Abstract

Aim: The present study analyzed clinical and biological factors that might predict achievement of tolerance in patients with IgE-mediated cow milk allergy (CMA). Method: Seventy patients with IgE-mediated CMA (44.24 ± 24.16 months) were included in the study. The patients were evaluated clinically through skin prick test and sIgE to whole milk, casein, beta-lactoglobulin and alpha-lactalbumin. An eviction diet of 6 months was established, followed by oral food challenge test (OFC) and oral immunotherapy (OIT) with baked milk for 6 months. The tolerance was assessed after 2 years follow up. Results: Thirty percent of patients presented anaphylaxis of different degrees of severity as first manifestation of CMA. Sixty-two patients followed OIT or an accelerated reintroduction of milk. Ten patients (14.28%) did not obtain tolerance to milk within 2 years. A larger wheal in SPT and higher sIgE to milk, casein and betalactoglobulin were noted in patients with positive OFC. A basal level of <2.5 kU/l for sIgE to milk and <11.73 kU/l for sIgE to caseins predicted the occurrence of tolerance in patients with all types of clinical manifestations, including anaphylaxis. Conclusion: Basal levels of sIgE to milk and casein may help to identify patients that could become tolerant to milk.

An overview of the current state of food desensitization

“…However, it has been suggested that of higher levels of CM-sIgE, greater wheal diameter and a high basophil activity decrease the likelihood of reaching tolerance [28]. Evaluation of these factors before initiating therapeutic therapy can help predict the success of CM-OIT [29].…”

β-КАЗЕИН Bos taurus: СТРУКТУРА БЕЛКА, ПОЛИМОРФИЗМ ГЕНА, ВЛИЯНИЕ НА ЖЕЛУДОЧНО-КИШЕЧНЫЙ ТРАКТ ЧЕЛОВЕКА (обзор)

“…Молоко, содержащее -казеин А1, вызывает более выраженное ухудшение желудочно-кишечных симптомов и увеличение времени транзита через желудочно-кишечный тракт у людей с непереносимостью лактозы, чем у толерантных к лактозе, тогда как молоко, содержащее β-казеин А2, не усугубляет симптомы при непереносимости лактозы (82)(83)(84). Это свидетельствует о том, что у некоторых людей с непереносимостью лактозы неблагоприятные желудочно-кишечные симптомы после употребления молока могут быть связаны с присутствием в нем β-казеина A1, а не с самой лактозой (76,85,86).…”

Mechanisms and biomarkers of successful allergen-specific immunotherapy

“…The role of sIgE as a potential predictive biomarker has been investigated in several food AIT studies. A recent study with 70 allergic children to CM showed that high baseline levels of sIgE to CM and casein are associated with persistence of CM allergy despite AIT [ 163 ]. This is consistent with the findings of Cohen et al [ 164 ] and Kauppila et al [ 165 ], demonstrating that elevated baseline levels of sIgE to total CM and its allergens are associated with a lower chance of reaching a maintenance dose of 200 mL of CM due to adverse reactions.…”

“…However, this association was not found in a peanut AIT study with 120 participants, which could be due to the recruitment criterium of SPT wheal diameter of ≥5 mm above the negative control instead of the conventional ≥3 mm [ 155 ]. Furthermore, the SPT wheal diameter was not a predictive marker for AIT outcome in a recent study with 70 CM-allergic children undergoing AIT or a more rapid introduction of baked milk [ 163 ]. Collectively, the contradictory results of these studies suggest that more work is needed to confirm the role of SPT wheal diameter as a predictive biomarker in AIT.…”