Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy |
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| Authors: | S Tolga Yavuz Betul Buyuktiryaki Umit M Sahiner Esra Birben Ayfer Tuncer Selin Yakarisik Erdem Karabulut Omer Kalayci Cansin Sackesen |
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| Institution: | 1. Faculty of Medicine, Department of Pediatric Allergy and Asthma, Hacettepe University, Ankara, Turkey;2. Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey;1. Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia;2. Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia;1. Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY;2. Immunology Institute, Mount Sinai School of Medicine, New York, NY;1. Department of Life Science and Biotechnology, University of Ferrara, I-44100 Ferrara, Italy;2. Organ Protection Program, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045, USA;3. Department of Pulmonary Medicine, University Hospital Freiburg, Freiburg, Germany;1. VI Division of General Surgery, AOU San Giovanni Battista, University of Torino, Italy;2. Division of Hematology and Cell Therapy, AO Ordine Mauriziano, University of Torino, Italy;3. Molecular Biotechnology Center (M.B.C.), University of Torino, Italy;4. Division of Nuclear Medicine, University of Torino, Italy;5. Division of Hematology, AOU San Giovanni Battista, University of Torino, Italy;1. Gastrointestinal Eosinophilic Diseases Program, Department of Pediatrics, Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, Colo;2. Section of Allergy and Immunology, Children''s Hospital Colorado, Aurora, Colo;1. Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan;2. Drug Development Research Laboratories, Kyoto R&D Center, Maruho Co., Ltd., Kyoto, Japan;3. Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan |
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| Abstract: | BackgroundSpecific IgE (sIgE) may be used for the diagnosis of cow's milk allergy (CMA) and as a guide to perform food challenge tests in patients with CMA. The effect of genetic variants on the prognosis of food allergy is largely unknown.ObjectiveTo examine the performance of sIgE analysis and the utility of the genetic variants of CD14, STAT6, IL13, IL10, SPINK5, and TSLP in predicting the clinical course in children with CMA.MethodsSerum sIgE levels of 94 children who underwent open food challenges and 54 children with anaphylaxis due to cow's milk (CM) were retrospectively analyzed between January 2002 and May 2009. The genetic polymorphisms were determined in 72 children.ResultsA total of 148 children were followed up for a median of 3.5 years, and 42 of the 94 challenge results were positive. The probability curves with 95% decision points were 2.8 kU/L for younger than 1 year, 11.1 for younger than 2 years, 11.7 for younger than 4 years, and 13.7 for younger than 6 years. Sixty-six children outgrew CMA during follow-up. Children with initial an CM sIgE level less than 6 kU/L outgrew CMA earlier than children with an initial CM sIgE level of 6 kU/L or higher (P < .001). The age of tolerance development for CM was significantly higher in children with the GG genotype at rs324015 of the STAT6 gene compared with those with the AA+AG genotype (2 years range, 1.5-3.9 years] vs 1.2 years range, 1.0-2.2 years]) (P = .02).ConclusionThe decision points of sIgE obtained in different age groups may help to determine the likelihood of clinical reactivity more precisely. The results suggest that sIgE levels and STAT6 gene variants may be important determinants to predict longer persistence of CMA. |
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