PURPOSE OF THE STUDY.
To describe the natural course of immunoglobulin (Ig)E-mediated cow’s milk (IgE-CMA) and the risk factors for its persistence in a prospective population-based study.
There were 54 infants identified with IgE-CMA from a population of 13 019 who were recruited and completed the study from the Assaf-Harofeh Hospital in Israel. This occurred during a 2-year period between June 2004 and June 2006. The children were followed from birth until 4 to 6 years.
Diagnosis of IgE-CMA was done based on history, skin-prick test, and an oral food challenge. These infants were followed for 48 to 60 months with families being contacted every 6 months to ask about exposures and reactions to milk. Children were invited to return annually for an oral food challenge for potential recovery unless an adverse reaction occurred within the preceding 3 months or they had already been exposed to milk without any adverse events. Statistical analysis was done through SPSS software (IBM SPSS Statistics, IBM Corporation, Chicago, IL).
Thirty-one infants (57.4%) recovered from IgE-CMA, most recovering within the first 2 years (70.9%). Risk factors for persistence of milk allergy included clinical reactions to <10 mL of milk on oral food challenge or on first exposure as determined by guardian, larger wheal size on skin testing with 6 mm as the cutoff determined to best differentiate between transient and persistent allergy, and an age of <30 days at time of first reaction.
Resolution occurs in most infants with IgE-CMA, but infants who react to <10 mL of milk, react within the first month of life, or have a wheal size larger than 6 mm are at increased risk for persistence of milk allergy.
This study helps to describe the clinical factors that can help the clinician counsel parents on the persistence of IgE-CMA. It does not, however, also describe whether the severity of reaction changes with this persistence. Continued studies to further delineate these factors will be of great benefit to parents with children who have milk allergy.
- Copyright © 2013 by the American Academy of Pediatrics