English summary: PREDICTION OF THE DEVELOPMENT OF TOLERANCE TO MILK IN CHILDREN WITH COW'S MILK HYPERSENSITIVITY

Background

Cow´s milk hypersensitivity (CMH) occurs in about 2-3% of infants in unselected cohorts. It has been reported to be immunoglobulin E (IgE)-mediated in 53-64% of these cases. However, in these studies, different diagnostic criteria, IgE cutoff levels, and different methods of IgE measurement were used. In prospective follow-up trials, CMH has been reported to persist to the age of 3 years in 13-49% of the children. There are conflicting reports of the usefulness of the skin prick test (SPT) or the specific IgE antibody levels in predicting the persistence of cow´s milk (CM) allergy.

Methods

The purpose of this study was to determine whether SPT results or IgE antibodies to CM in infancy could predict the development of clinical tolerance in children with CMH. The children were followed prospectively to the age of 4 years.

The diagnosis of CMH was based on double-blind, placebo-controlled food challenge, and specific IgE-levels were measured by the Pharmacia UniCAP 100 System.

Results

In this prospective study, persistent CMH was shown to relate to IgE-mediated allergy with immediate symptoms in infancy. Delayed, often gastrointestinal, symptoms in a milk challenge, a negative or a small (<5 mm) wheal reaction in the SPT, and low specific (<2 kU/L) IgE levels at the onset of CMH favour the development of tolerance by the age of 4 years.

Conclusions

SPT and milk-specific IgE in the serum are useful prognostic indicators of the development of tolerance to CM in infants with CMH.