BACKGROUND: 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. OBJECTIVE: To define the natural course of CMA and identify the factors that best predict outcome in a large referral population of children with CMA. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL IMPLICATIONS: 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.
BACKGROUND: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. OBJECTIVE: To define the natural course of CMA and identify the factors that best predict outcome in a large referral population of children with CMA. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL IMPLICATIONS: 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.
Authors: Scott H Sicherer; Robert A Wood; Donald Stablein; A Wesley Burks; Andrew H Liu; Stacie M Jones; David M Fleischer; Donald Y M Leung; Alexander Grishin; Lloyd Mayer; Wayne Shreffler; Robert Lindblad; Hugh A Sampson Journal: J Allergy Clin Immunol Date: 2010-05 Impact factor: 10.793
Authors: D Venkataraman; M Erlewyn-Lajeunesse; R J Kurukulaaratchy; S Potter; G Roberts; S Matthews; S H Arshad Journal: Clin Exp Allergy Date: 2018-02-08 Impact factor: 5.018
Authors: Justin M Skripak; Scott D Nash; Hannah Rowley; Nga H Brereton; Susan Oh; Robert G Hamilton; Elizabeth C Matsui; A Wesley Burks; Robert A Wood Journal: J Allergy Clin Immunol Date: 2008-10-25 Impact factor: 10.793
Authors: Anders van Thuijl; Anne-Fleur Schoemaker; Stef Menting; Jennifer van Dulmen; Janne Boeting; Wim van Aalderen; Gerben ter Riet; Aline Sprikkelman Journal: Eur J Pediatr Date: 2012-12-08 Impact factor: 3.183
Authors: Lisa M Bartnikas; William J Sheehan; Elaine B Hoffman; Perdita Permaul; Anahita F Dioun; James Friedlander; Sachin N Baxi; Lynda C Schneider; Wanda Phipatanakul Journal: Ann Allergy Asthma Immunol Date: 2012-08-21 Impact factor: 6.347