Skripak Justin M, Matsui Elizabeth C, Mudd Kim, Wood Robert A
Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Allergy Clin Immunol. 2007 Nov;120(5):1172-7. doi: 10.1016/j.jaci.2007.08.023. Epub 2007 Nov 1.
Cow's milk allergy (CMA) is the most common food allergy in infants and young children, affecting 2% to 3% of the general population. Most studies have shown the prognosis of developing tolerance to cow's milk to be good, with most outgrowing their allergy by age 3 years.
To define the natural course of CMA and identify the factors that best predict outcome in a large referral population of children with CMA.
Clinical history, test results, and final outcome were collected on 807 patients with IgE-mediated CMA. Patients were considered tolerant after they passed a challenge or experienced no reactions in the past 12 months and had a cow's milk IgE (cm-IgE) level <3 kU/L.
Rates of resolution were 19% by age 4 years, 42% by age 8 years, 64% by age 12 years, and 79% by 16 years. Patients with persistent allergy had higher cm-IgE levels at all ages to age 16 years. The highest cm-IgE for each patient, defined as peak cm-IgE, was found to be highly predictive of outcome (P < .001). Coexisting asthma (P < .001) and allergic rhinitis (P < .001) were also significant predictors of outcome.
The prognosis for CMA in this population is worse than previously reported. However, some patients developed tolerance during adolescence, indicating that follow-up and re-evaluation of CMA patients is important in their care. cm-IgE level is highly predictive of outcome.
The increasing potential for persistence of CMA, along with cm-IgE level's effect on prognosis, should be considered when counseling families regarding expected clinical course.
牛奶过敏（CMA）是婴幼儿中最常见的食物过敏，影响着2%至3%的普通人群。大多数研究表明，对牛奶产生耐受的预后良好，大多数患儿在3岁时过敏症状会消失。
明确CMA的自然病程，并确定在大量转诊的CMA儿童人群中最能预测结局的因素。
收集了807例IgE介导的CMA患者的临床病史、检测结果和最终结局。在患者通过激发试验或在过去12个月内无反应且牛奶IgE（cm-IgE）水平<3 kU/L后，判定为耐受。
4岁时缓解率为19%，8岁时为42%，12岁时为64%，16岁时为79%。持续过敏的患者在16岁之前的各年龄段cm-IgE水平均较高。发现每位患者的最高cm-IgE（定义为cm-IgE峰值）对结局具有高度预测性（P <.001）。并存哮喘（P <.001）和过敏性鼻炎（P <.001）也是结局的重要预测因素。
该人群中CMA的预后比先前报道的更差。然而，一些患者在青春期出现耐受，这表明对CMA患者进行随访和重新评估对其治疗很重要。cm-IgE水平对结局具有高度预测性。
在向家庭咨询预期临床病程时，应考虑CMA持续存在的可能性增加以及cm-IgE水平对预后的影响。
