The natural history of milk allergy in an observational cohort

Abstract

Objective There are few studies on the natural history of milk allergy. Most are single-site and not longitudinal, and these have not identified a means for early prediction of outcomes. Methods Children aged 3 to 15 months were enrolled in an observational study with either (1) a convincing history of egg allergy, milk allergy, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis (AD) and a positive SPT response to milk or egg. Children enrolled with a clinical history of milk allergy were followed longitudinally, and resolution was established by means of successful ingestion. Results The cohort consists of 293 children, of whom 244 were given a diagnosis of milk allergy at baseline. Milk allergy has resolved in 154 (52.6%) subjects at a median age of 63 months and a median age at last follow-up of 66 months. Baseline characteristics that were most predictive of resolution included milk-specific IgE level, milk SPT wheal size, and AD severity (all P < .001). Baseline milk-specific IgG4 level and milk IgE/IgG4 ratio were not predictive of resolution and neither was expression of cytokine-inducible SH2-containing protein, forkhead box protein 3, GATA3, IL-10, IL-4, IFN-γ, or T-bet by using real-time PCR in CD25-selected, casein-stimulated mononuclear cells. A calculator to estimate resolution probabilities using baseline milk IgE level, SPT response, and AD severity was devised for use in the clinical setting. Conclusions: In this cohort of infants with milk allergy, approximately one half had resolved over 66 months of follow-up. Baseline milk-specific IgE level, SPT wheal size, and AD severity were all important predictors of the likelihood of resolution.

IgE-Mediated Cow’s Milk Allergy in Iranian Infants and Children: Predictive Factors of Early Tolerance

“…Similar to our result, several studies found a relationship between atopic dermatitis and intolerance to cow's milk in CMA infants and children; however, moderate to severe type of atopic dermatitis was associated with a lower likelihood of developing tolerance (15,16). History of sensitization to certain foods such as egg has been reported with a worse prognosis in early life, but no significant association with intolerance to cow's milk was observed in this study (9).…”

“…In 9 European countries, 69% of children with CMA tolerated cow's milk one year after diagnosis, and all children with non IgE-mediated CMA and 57% of those with IgE-mediated CMA did so (14). A large cohort of 512 infants and children with CMA ranging from 3 to 15 months of age at 5 areas of the USA demonstrated a resolution rate of about 50% by age 5 (15). A natural course of CMA in 115 Korean children < 24 months of age with atopic dermatitis showed 50% tolerance at 67 months of age (16).…”

Concerning Diet Duration at Cow’s Milk Protein Allergy. How and When Should Dairy Products Be Introduced Again?

“…Выявлено влияние на прогноз развития толерант-ности к БКМ полиморфизма гена rs324015, ответствен-ного за выработку фактора транскрипции STAT6 и учаcтвующего в дифференциации Th2 [10].…”

“…Напротив, заболевания с более поздним началом симптомов, кож-ными проявлениями, а также IgE-опосредованные фор-мы склонны к персистированию и требуют повторной оценки уровня специфических IgE в возрасте ~ 1 года [43]. В то же время тяжелые случаи аллергии к БКМ, как IgE-зависимые, так и не-IgE-зависимые, персисти-руют длительно, и дети могут никогда их не «перерасти» [10,43]. В целом, исследования показывают, что перси-стирующая аллергия к БКМ характеризуется значитель-но отягощенным семейным анамнезом по атопическим болезням, более длительным периодом между началом употребления БКМ и появлением первых симптомов аллергии, большей частотой множественных реакций на пищу и наличием других аллергических заболева-ний.…”

“…До недавнего времени считалось, что до 80-90% детей с аллергией к БКМ формируют толерантность в первые 3-5 лет жизни [1,10,61]. Однако, по послед-ним данным, формирование переносимости происходит в более поздние сроки [7,33].…”