Long-Term Outcome of IgE-Mediated Cow's Milk Allergy and Risk Factors for Persistence

Area of Science:

• Pediatric Allergy and Immunology
• Immunology
• Clinical Medicine

Background:

• IgE-mediated cow's milk allergy (IgE-CMA) resolution rates by age 5 and persistence risk factors were previously established.
• This study extends follow-up to assess IgE-CMA resolution and persistence into adolescence.

Purpose of the Study:

• To determine the rate of spontaneous resolution of IgE-CMA by age 17 years.
• To identify risk factors associated with the persistence of IgE-CMA into late adolescence.

Main Methods:

• Follow-up study of 23 patients with IgE-CMA who were still allergic at age 5, extending to age 17.
• Resolution assessed by milk consumption or negative oral food challenge (OFC); allergy confirmed by reaction and skin prick test (SPT) or high positive predictive value (PPV) sensitization.
• Risk factors for persistence analyzed in the entire cohort of 54 patients.

Main Results:

• Overall, 72.2% of patients achieved spontaneous resolution by age 17.
• Persistence at age 17 was associated with SPT >6 mm at diagnosis, no early cow's milk formula feeding, and wheezing during initial reaction.
• Seven patients had reactions after age 5, often associated with wheezing, anaphylaxis, or current asthma.

Conclusions:

• Spontaneous resolution of IgE-CMA continues significantly beyond age 5 into adolescence.
• Few patients experience reactions in early adulthood, primarily those with asthma.
• Treatment strategies for IgE-CMA should consider the potential for late-onset resolution.