Nieminen Otso, Palosuo Kati, Mäkelä Mika J
Department of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Pediatr Allergy Immunol. 2025 Jul;36(7):e70152. doi: 10.1111/pai.70152.
Up to 83% of children with cow's milk allergy (CMA) tolerate baked milk, but research on heated milk (HM) tolerance and allergen-specific IgE (sIgE) cutoff values predicting oral food challenge (OFC) outcomes are lacking. We hypothesized that casein sIgE is the best predictor for HM tolerance.
Finnish children suspected of having IgE-mediated CMA were recruited. sIgE levels to milk, casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin were measured alongside skin prick tests (SPT) to fresh milk (FM) and HM. The diagnosis was confirmed with an FM OFC. IgE-sensitized children with a positive FM OFC underwent an HM OFC with extensively heated milk in rice porridge. Cutoff values to predict HM OFC outcome were determined, reaction severity analyzed, and effect of age investigated.
Of the 158 children (median age: 2.59 years) undergoing FM OFC, 127 proceeded to an HM OFC. Of these, 77 (61%) demonstrated HM tolerance. Casein sIgE emerged as the best predictor for the HM OFC outcome (AUC 0.786), with a 95% sensitivity cutoff value of <0.54 kU/L and a 95% specificity cutoff value of >14.1 kU/L. Most HM OFC reactions were mild (66%), but reaction severity was unpredictable. Casein sIgE, milk sIgE, and HM SPT showed greater accuracy in ≤3-year-old children.
Casein sIgE cutoffs <0.54 and >14.1 kU/L can help identify children with a high or low likelihood of HM tolerance. This approach may reduce unnecessary OFCs in high-risk patients and guide safe dietary advancement on a milk ladder in low-risk cases.
高达83%的牛奶过敏（CMA）儿童耐受烘焙牛奶，但缺乏关于热牛奶（HM）耐受性及预测口服食物激发试验（OFC）结果的过敏原特异性IgE（sIgE）临界值的研究。我们假设酪蛋白sIgE是HM耐受性的最佳预测指标。
招募疑似患有IgE介导的CMA的芬兰儿童。检测牛奶、酪蛋白、α-乳白蛋白、β-乳球蛋白和牛血清白蛋白的sIgE水平，同时对新鲜牛奶（FM）和HM进行皮肤点刺试验（SPT）。通过FM OFC确诊。对FM OFC阳性的IgE致敏儿童用米粥中充分加热的牛奶进行HM OFC。确定预测HM OFC结果的临界值，分析反应严重程度，并研究年龄的影响。
在接受FM OFC的158名儿童（中位年龄：2.59岁）中，127名进行了HM OFC。其中，77名（61%）表现出HM耐受性。酪蛋白sIgE成为HM OFC结果的最佳预测指标（曲线下面积0.786），95%敏感性临界值<0.54 kU/L，95%特异性临界值>14.1 kU/L。大多数HM OFC反应为轻度（66%），但反应严重程度不可预测。酪蛋白sIgE、牛奶sIgE和HM SPT在≤3岁儿童中显示出更高的准确性。
酪蛋白sIgE临界值<0.54和>14.1 kU/L有助于识别HM耐受性高或低可能性的儿童。这种方法可能减少高危患者不必要的OFC，并在低风险病例中指导在牛奶阶梯上安全地逐步增加饮食。
