Uncuoglu A, Cogurlu M T, Eser Simsek I, Ergul N, Baydemir C, Aydogan M
Division of Pediatric Gastroenterology Hepatology and Nutrition, Kocaeli University Faculty of Medicine, Turkey.
Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Turkey.
Allergol Immunopathol (Madr). 2019 Sep-Oct;47(5):449-456. doi: 10.1016/j.aller.2018.12.007. Epub 2019 Feb 10.
Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODP) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old.
SPTs for CE and FM, tests for sIgEs (cow's milk, casein, α-lactoalbumin, β-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis.
Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODP of 7mm, 9mm, and 10.5kU/L, respectively; these values remained higher with ODP of 4mm, 11mm, and 10.5kU/L at the last OFC.
Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5kU/L and initial SPT for fresh milk <9mm are related to the acquisition of tolerance in the follow-up period.
针对2岁以下儿童和/或涉及鲜牛奶皮肤点刺试验（SPT）的研究有限，这些研究探讨了变应原检测对牛奶过敏（CMA）消退的预测价值。我们研究了使用商业牛奶提取物（CE）和鲜牛奶进行SPT以及牛奶蛋白特异性免疫球蛋白E（sIgE）水平的最佳消退决策点（ODP），以预测2岁以下儿童过敏的消退情况。
对因疑似CMA转诊评估的儿童以及诊断后15个月进行CE和鲜牛奶的SPT、sIgE检测（牛奶、酪蛋白、α-乳白蛋白、β-乳球蛋白）和口服食物激发试验（OFC）。
共纳入51名儿童（中位年龄7.5个月；范围2 - 23个月）。5名有过敏反应史，48名初次激发试验阳性的儿童中有26名进行了牛奶回避。最后一次OFC在28名儿童中进行，其中13名对牛奶有反应。持续CMA患者诊断时对CE和鲜牛奶的初始SPT反应以及牛奶sIgE水平较高，ODP分别为7mm、9mm和10.5kU/L；在最后一次OFC时，这些值仍较高，ODP分别为4mm、11mm和10.5kU/L。
鲜牛奶和CE的初始SPT较高以及牛奶蛋白的初始sIgE水平较高与消退可能性降低相关。初始牛奶sIgE水平<10.5kU/L以及鲜牛奶初始SPT<9mm与随访期内获得耐受性有关。
