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Cow's milk allergic children-Can component-resolved diagnostics predict duration and severity?
Thomas Houmann Petersen1, Charlotte Gotthard Mortz1, Carsten Bindslev-Jensen1
1Department of Dermatology & Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark.
Summary
Component-resolved diagnostics (CRD) correlate with cow's milk allergy (CMA) severity and persistence. High CRD levels indicate a higher risk of long-lasting CMA, but oral food challenges remain essential for diagnosis.
Area of Science:
- Pediatric Allergy and Immunology
- Diagnostic Immunology
Background:
- Cow's milk allergy (CMA) affects approximately 2% of children.
- Component-resolved diagnostics (CRD) offer detailed insights into specific allergen sensitization.
Purpose of the Study:
- To correlate CRD levels with oral food challenge outcomes in children suspected of CMA.
- To assess if serial CRD measurements can differentiate persistent CMA from developing tolerance.
Main Methods:
- Retrospective analysis of 78 children with suspected CMA over 13 years.
- Collection of oral food challenge data (threshold, severity) and sensitization markers (s-IgE, SPT).
- Regular re-evaluation of allergic children with sensitization data and repeat challenges.
Main Results:
- Persistent CMA cases showed significantly larger SPT wheal sizes and higher s-IgE to milk and CRD at inclusion.
- SPT wheal size was a key differentiator between persistent CMA and outgrowing CMA.
- A correlation was observed between s-IgE to cow's milk/casein and allergic reaction severity.
Conclusions:
- Oral food challenges are indispensable for diagnosing CMA and cannot be substituted by s-IgE or SPT alone.
- Elevated milk component and s-IgE levels are associated with an increased risk of persistent CMA.