Predictors of a positive oral food challenge to cow's milk in children sensitized to cow's milk |
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| Institution: | 1. Department of Allergy and Immunology, Ali Asghar children''s Hospital, Iran University of Medical Sciences, Tehran, Iran;2. Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran;3. Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran;4. Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children''s Medical Center, Tehran University of Medical Science, Tehran, Iran;5. Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Educationan and Research Netwrork (USERN), Tehran, Iran;1. Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig City, Al Sharqia Governorate, Egypt;2. Department of Medical Microbiology & Immunology, Faculty of Medicine, Zagazig University, Zagazig City, Al Sharqia Governorate, Egypt;3. Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig City, Al Sharqia Governorate, Egypt;1. School of Pharmacy, Lebanese International University, Beirut, Lebanon;2. Life sciences and health department, Paris-Est University, Paris, France;3. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon;4. INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie – Liban, Beirut, Lebanon;5. Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon;6. Infectious Disease Department, Bellevue Medical center, Mansourieh, Lebanon;7. Infectious Disease Department, Notre-Dame Des Secours University Hospital, Byblos, Lebanon;8. Faculty of Pharmacy, Lebanese University, Beirut, Lebanon;9. Faculty of Medicine, Lebanese University, Beirut, Lebanon;1. SBU Izmir Dr Behcet Uz Children''s Education and Research Hospital, Izmir, Turkey;2. Bal?kesir University Medical, Faculty Hospital, Department of Pediatrics, Division of Immunology and Allergy Clinic, Bal?kesir, Turkey;3. Department of Pediatrics, Division of Immunology and Allergy Clinic, Izmir, Turkey |
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| Abstract: | Introduction and objectivesThe diagnosis of IgE-mediated cow's milk allergy (CMA) is often based on clinical history and on specific IgE levels and/or skin-prick tests (SPT), both of which are sensitive but not specific. The gold standard, oral food challenge (OFC), is expensive and time-consuming and involves a risk of severe allergic reactions. This study aimed to determine the value of specific IgEs, ratios of specific IgEs for cow's milk and its components to total IgE, and wheal size on SPT for predicting a positive OFC for CMA.Material and methodsWe retrospectively studied 72 patients median age, four years; age range 0.75–15 years] sensitized to cow's milk who underwent OFCs to milk. predictive variables between patients with positive and negative OFCs were compared. Receiver operator characteristic (ROC) curves were uses to assess variables’ discriminatory capacity and Youden's index to determine the best cut-offs for predicting CMA.ResultsThe OFC was positive in 39 (54%) patients. Wheal size on SPT and all specific IgEs and specific-to-total IgE ratios were significantly different between patients with positive OFCs and those with negative OFCs (p < 0.001). The variable with the greatest area under the ROC curve was casein-specific IgE (0.98), followed by β-lactoglobulin-specific IgE (0.923), casein-specific-to-total-IgE ratio (0.919), and α-lactalbumin-specific IgE (0.908). Casein-specific IgE ≥0.95 kU/L yielded 88.9% sensitivity and 90.9% specificity.ConclusionsIn our center, casein-specific IgE >0.95 kU/L can obviate an OFC to cow's milk for the diagnosis of CMA in patients sensitized to cow's milk with a compatible history. |
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| Keywords: | Cow's milk allergy Food allergy Specific immunoglobulin E Oral food challenge Skin-prick test Children |
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