Cow's milk allergy: Evaluating tolerance through skin-prick test

Area of Science:

• Allergy and Immunology
• Pediatric Allergy
• Clinical Dermatology

Background:

• Cow's milk protein allergy (CMPA) is common in children.
• Assessing tolerance development is crucial for managing CMPA.
• Skin-prick tests (SPT) are a common diagnostic tool.

Purpose of the Study:

• To compare wheal diameters in SPT for cow's milk extract (CM) between children who developed tolerance and those who persisted with CMPA.
• To evaluate the utility of serial SPT in monitoring CMPA.
• To identify potential indicators for oral food challenge (OFC) testing.

Main Methods:

• Retrospective cohort study of children diagnosed with IgE-mediated CMPA.
• Analysis of SPT data from January 2000 to July 2015.
• Comparison of wheal diameters at diagnosis and over time between tolerant and persistent groups.

Main Results:

• The tolerant group showed a significant reduction in SPT wheal diameter from 6 mm at diagnosis to 2 mm upon tolerance (p<0.0001).
• The persistent group had no significant change in SPT wheal diameter (7 mm at diagnosis to 5 mm, p=0.173).
• A greater than 50% reduction in SPT wheal diameter was observed in the tolerant group compared to the persistent group (p=0.001).

Conclusions:

• Serial SPTs are valuable for diagnosing and monitoring CMPA.
• A decrease in SPT wheal diameter exceeding 50% may signal readiness for OFC testing.
• This approach aids in accurately detecting tolerance in children with CMPA.