Diagnostic value of skin and laboratory tests in cow's milk allergy/intolerance

The applicability of a panel of five skin and laboratory tests in the diagnosis of cow's milk allergy/intolerance (CMAI) was investigated. The tests used were prick and patch tests, RAST, basophil histamine release test (BHRT) and lymphocyte proliferation test (LPT). Twenty-two atopic children who had experienced either immediate or delayed cutaneous symptoms upon challenge with cow's milk (CM), and 12 non-milk-allergic controls with atopic dermatitis (AD) were included in the study. RAST, prick test, BHRT and LPT to CM and patch test to alpha-casein were positive in the CMAI group and non-milk-allergic atopic controls as follows: 59% and 33%, 57% and 0%, 55% and 17%, 77% and 17%, 33% and 0%. RAST, prick test and BHRT were more often positive in children exhibiting immediate reactions, and patch test and LPT more often positive in those having delayed reactions to CM. The panel of five tests detected 21/22 children with CMAI and gave false-positive results in 5/12 of non-milk allergic controls. The sensitivity and specificity of the panel in the diagnosis of CMAI were 95% and 58%, respectively.