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Accidental allergic reactions in children allergic to cow's milk proteins
Teresa Boyano-Martínez1, Carmen García-Ara, María Pedrosa
1Servicio de Alergia Infantil, Hospital Universitario La Paz, Madrid, Spain. med012396@saludalia.com
Insights
Accidental exposure to cow's milk causes frequent reactions in allergic children, with 15% being severe. High IgE levels and asthma are key risk factors for these reactions.
Area of Science:
- Pediatric Allergy and Immunology
- Food Allergy Research
- Clinical Immunology
Background:
- Cow's milk allergy is a prevalent food allergy in children.
- Accidental food exposure is common among allergic individuals.
- Limited research exists on accidental exposure, particularly for cow's milk allergy.
Purpose of the Study:
- To determine the incidence of accidental exposure reactions in children with cow's milk allergy over 12 months.
- To analyze the clinical features and circumstances of these reactions.
- To identify risk factors associated with severe reactions.
Main Methods:
- A cohort of 88 children with cow's milk allergy was studied.
- A structured questionnaire assessed accidental exposure incidents.
- Reactions were categorized by severity (mild, moderate, severe), and specific IgE levels to cow's milk and casein were measured.
Main Results:
- 40% of children experienced 53 reactions within a year, with 15% classified as severe.
- Most reactions occurred at home during routine activities.
- Elevated cow's milk-specific IgE levels correlated with reaction severity.
- Asthmatic children had a 10-fold increased risk of severe reactions.
Conclusions:
- Accidental exposure reactions are common in pediatric cow's milk allergy.
- Severe reactions constitute 15% of all reactions.
- High specific IgE levels to cow's milk/casein and co-existing asthma are significant risk factors for severe reactions.
Background:
Cow's milk is the main cause of food allergy in children. Patients allergic to food frequently experience accidental exposure. There are few studies analyzing this problem, most of them concerning peanut allergy.
Objective:
We sought to calculate the frequency of accidental exposure reactions in children allergic to cow's milk during a 12-month period, to analyze the clinical characteristics and circumstances surrounding the reactions, and to identify risk factors for severe reactions.
Methods:
Eighty-eight children allergic to cow's milk (44 boys; median age, 32.5 months) were included in the study. A systematized questionnaire about accidental exposure was used. Reactions were classified as mild, moderate, and severe. Cow's milk- and casein-specific IgE antibody titers were determined.
Results:
Thirty-five (40%) children had 53 reactions in the previous year (53% mild, 32% moderate, and 15% severe). Most reactions took place at home (47%) under daily life circumstances (85%). Specific IgE levels to cow's milk were higher in children with severe reactions than in those with moderate (median, 37.70 vs 7.71 KUA/L; P = .04) or mild (3.37 KUA/L; P = .04) reactions. The frequency of severe reactions was 10-fold higher in asthmatic children (odds ratio, 10.2; 95% CI, 1.13-91.54).
Conclusions:
Reactions to accidental exposure are frequent in children with cow's milk allergy. The proportion of severe reactions was 15%. The risk factors for such reactions included very high levels of specific IgE to cow's milk and casein and asthma.
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