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Molecular Allergy Diagnostics in Children with Cow's Milk Allergy: Prediction of Oral Food Challenge Response in
Maria Angela Tosca1, Irene Schiavetti2, Roberta Olcese1
1Allergy Center, IRCCS Giannina Gaslini, Genoa, Italy.
Insights
Cow's milk allergy (CMA) diagnosis in children can be aided by specific IgE cutoff values. These values help predict a positive oral food challenge (OFC) response, guiding diagnostic decisions for CMA.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Diagnostics
- Immunopathology
Background:
- Cow's milk allergy (CMA) is a prevalent food allergy in early childhood, necessitating accurate and timely diagnosis.
- Oral food challenge (OFC) is the established gold-standard for diagnosing food allergies, but it is resource-intensive and requires specialized settings.
- Identifying reliable biomarkers can streamline the diagnostic process for CMA.
Purpose of the Study:
- To determine specific cutoff values for serum allergen-specific IgE that can predict a positive oral food challenge (OFC) response in children with suspected cow's milk allergy (CMA).
Main Methods:
- Seventy-two children with suspected CMA underwent OFC with cow's milk (CM) or its derivatives.
- Serum total IgE and specific IgE levels against raw CM, α-lactalbumin, β-lactoglobulin, and casein were quantified.
- Statistical analysis was performed to identify significant predictive factors and establish IgE cutoff values.
Main Results:
- Out of 72 children, 30 (41.6%) exhibited a positive OFC response.
- Sensitization to raw CM extract (p=0.03), α-lactalbumin (p=0.013), β-lactoglobulin (p=0.09), and casein (p=0.019) were significant predictors of a positive OFC.
- Established cutoff values were: 5.13 kUA/L for raw CM, 1.47 for α-lactalbumin, 1.35 for β-lactoglobulin, and 4.87 for casein.
Conclusions:
- This study established predictive cutoff values for cow's milk protein-specific IgE, aiding in the interpretation of allergy test results.
- These cutoffs are not diagnostic for CMA but serve as valuable predictors for OFC response in a specific patient population.
- Elevated IgE levels above these defined cutoffs can help identify children who are likely to have a positive OFC, optimizing the OFC selection process.
Background:
Cow's milk allergy (CMA) is the most common food allergy in early childhood. Children with CMA require a precise and punctual diagnosis. Oral food challenge (OFC) is the gold-standard procedure for diagnosing allergies, but it is laborious and requires a particular setting. The aim of the study was to identify the cutoff value of serum allergen-specific IgE values able to predict a positive response to OFC.
Methods:
Children with suspected CMA performed OFC with cow's milk (CM) or derivatives. Total IgE and specific IgE to raw CM, α-lactalbumin, β-lactoglobulin, and casein were measured.
Results:
Seventy-two children performed OFC, and 30 (41.6%) had a positive response. The significant predictive factors were sensitization to raw CM extract (p = 0.03), α-lactalbumin (p = 0.013), β-lactoglobulin (p = 0.09), and casein (p = 0.019). The cutoff was, respectively: 5.13 kUA/L for raw CM, 1.47 for α-lactalbumin, 1.35 for β-lactoglobulin, and 4.87 for casein.
Conclusions:
This study allowed us to define a set of cutoff values for CM protein-specific IgE. However, these cutoffs should be interpreted not as a diagnostic tool for CMA but only predictive of response to OFC in a specific territory. Thus, the practical message may be that a value above the cutoff allows a good approximation to identify children to be started on OFC.
