Individual cow's milk allergens as prognostic markers for tolerance development?

Area of Science:

• Allergy and Immunology
• Pediatric Allergy
• Clinical Diagnostics

Background:

• Cow's milk allergy (CMA) is a prevalent food allergy in early childhood.
• Most children outgrow CMA, but predicting tolerance development is challenging.
• Lack of reliable prognostic markers hinders personalized management of CMA.

Purpose of the Study:

• To evaluate if IgE levels to specific cow's milk allergens can predict tolerance development.
• To identify reliable biomarkers for distinguishing persistent CMA from outgrown CMA.
• To assess the utility of component-resolved diagnostics in predicting CMA prognosis.

Main Methods:

• Followed 52 children diagnosed with CMA via DBPCFC.
• Assessed specific IgE, IgG, and IgG4 to crude cow's milk protein and individual allergens.
• Performed serial serological analysis prior to repeated oral food challenges.

Main Results:

• Low levels of IgE to cow's milk (CM)-specific IgE, α-lactalbumin, β-lactoglobulin, κ-casein, and α(s1)-casein correlated with outgrowing CMA.
• IgE levels to total casein, lactoferrin, β-casein, and β-lactoglobulin (Bos d5.0101) did not show significant correlation.
• Specific IgG and IgG4 levels were not useful predictors of tolerance development.

Conclusions:

• CM-specific IgE, particularly to individual allergens, serves as a valuable prognostic marker for CMA persistence.
• Component-resolved diagnostics offer similar predictive value but may not be cost-effective for routine use.
• Measurement of specific IgG or IgG4 antibodies is not recommended for predicting tolerance in CMA.