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Skin prick test tied to cow’s milk allergy persistence

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Skin prick testing results and early reactions are among indicators of the course of IgE-mediated cow’s milk allergy (CMA) in infants, Israeli researchers report in an April 4th on-line paper in the Journal of Pediatrics.

“The main finding of this study,” Dr. Arnon Elizur told Reuters Health by email, “is the identification of parameters for predicting persistence of cow’s milk allergy. These parameters are unique as they could be easily applied into clinical practice and thereby assist pediatricians in the management of infants with cow’s milk allergy.”

Dr. Elizur of Assaf Harofeh Medical Center, Zerefin and colleagues note that most infants with this potentially fatal food allergy recover, but it is unclear what factors are predictive.

To investigate further, the team conducted a prospective cohort study of 54 infants with IgE-CMA. Diagnosis was based on history, skin prick test (SPT), and an oral food challenge if conducted.

They were followed from 4 to 5 years. Families were contacted every 6 months and asked about recent exposures to milk. Oral food challenge was used to evaluate whether recovery had been achieved.

In all, 31 (57.4%) of the infants recovered during the study period. Most (70.9%) did so within 2 years.

Multivariate analysis showed that among risk factors for persistence were a reaction to less than 10 mL of milk on oral food challenge or on first exposure as estimated by the guardian. This was also the case for larger wheal size on SPT and being aged 30 days or less at the time of first reaction.

“Our findings,” say the investigators, “are in agreement with previous studies suggesting that patients with more severe disease recover less frequently.”

Commenting on treatment of those who do not recover, Dr. Elizur added that “for many years strict avoidance of milk products was the only way to manage these infants. However, in recent years, a new form of therapy called oral immunotherapy was developed. Even milk allergic patients can tolerate a certain amount, albeit minute, of milk protein. The idea is that daily exposure to that small amount of cow’s milk protein that can be tolerated by the patient gradually leads to the development of tolerance.”

“This form of therapy,” Dr. Elizur added, “is still at its beginning and there are many aspects of it that are not clear yet. It can be and is provided only in several specialty clinics around the world, including our center in Israel. We offer this therapy for children 4 years and older because the chance for spontaneous resolution of their cow’s milk allergy is small, and they are old enough to understand and cooperate with the program.”


Natural Course and Risk Factors for Persistence of IgE-Mediated Cow’s Milk Allergy

J Pediatr 2012.