The natural history of milk allergy in an observational cohort.
2013 Mar
Journal Article
Authors:
Wood, R.A.;
Sicherer, S.H.;
Vickery, B.P.;
Jones, S.M.;
Liu, A.H.;
Fleischer, D.M.;
Henning, A.K.;
Mayer, L.;
Burks, W.;
Grishin, A.;
Stablein, D.;
Sampson, H.A.
Secondary:
J Allergy Clin Immunol
Volume:
131
Pagination:
805-12
Issue:
3
PMID:
23273958
DOI:
10.1016/j.jaci.2012.10.060
Keywords:
Animals; Child, Preschool; Dermatitis, Atopic; Female; Humans; Immune Tolerance; Immunoglobulin E; Immunoglobulin G; Infant; Leukocytes, Mononuclear; Longitudinal Studies; Male; Milk; Milk Hypersensitivity; Skin Tests
Abstract:
OBJECTIVE: There are few studies on the natural history of milk allergy. Most are single-site and not longitudinal, and these have not identified a means for early prediction of outcomes.METHODS: Children aged 3 to 15 months were enrolled in an observational study with either (1) a convincing history of egg allergy, milk allergy, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis (AD) and a positive SPT response to milk or egg. Children enrolled with a clinical history of milk allergy were followed longitudinally, and resolution was established by means of successful ingestion.RESULTS: The cohort consists of 293 children, of whom 244 were given a diagnosis of milk allergy at baseline. Milk allergy has resolved in 154 (52.6%) subjects at a median age of 63 months and a median age at last follow-up of 66 months. Baseline characteristics that were most predictive of resolution included milk-specific IgE level, milk SPT wheal size, and AD severity (all P < .001). Baseline milk-specific IgG4 level and milk IgE/IgG4 ratio were not predictive of resolution and neither was expression of cytokine-inducible SH2-containing protein, forkhead box protein 3, GATA3, IL-10, IL-4, IFN-γ, or T-bet by using real-time PCR in CD25-selected, casein-stimulated mononuclear cells. A calculator to estimate resolution probabilities using baseline milk IgE level, SPT response, and AD severity was devised for use in the clinical setting.CONCLUSIONS: In this cohort of infants with milk allergy, approximately one half had resolved over 66 months of follow-up. Baseline milk-specific IgE level, SPT wheal size, and AD severity were all important predictors of the likelihood of resolution.
