Natural Course of Egg, Milk and Peanut Allergy Using a Novel Diagnostic Scheme: 1 Year Follow-Up in an Observational Study (CoFAR2) of Food Allergy
Year of Publication
Sicherer, S.; Stablein, D.; Wood, R.; Burks, A.; Liu, A.; Jones, S.; Fleischer, D.; Leung, D.; Lindblad, R.; Sampson, H.; Consortium of Food Allergy Research, C.
2009 Annual Meeting of the American Academy of Allergy, Asthma, and Immunology
RATIONALE: We enrolled 3-15 month olds (n = 512) with likely egg/milk allergy without known current peanut allergy for an observational study of egg, milk and peanut allergy. Here we report 1 year follow-up using a novel diagnostic scheme. METHODS: A diagnostic scheme was developed and applied using food-specific IgE levels, skin tests and clinical history/food challenge. Participants were diagnosed as “Allergic” (convincing histories/challenge/diagnostic tests), “Serologic diagnosis” (food never ingested but food-specific IgE exceeded diagnostic levels), “Potential allergy” (history/tests suggestive/not definitive of allergy), “Tolerant” and “non-IgE allergy”. Transitions from categories “allergic/serologic” to “tolerant” were considered “resolved” and the reverse “developed” a food allergy. RESULTS: A total of 293 (median age at enrollment, 10 mo) subjects completed 1 year follow-up. Initial categories were: MILK- 48% allergic, 5% serologic diagnosis, 22% potential allergy and 25% tolerant; EGG- 29% allergic, 36% serologic, 23% potential, 13% tolerant; PEANUT- 0% allergic, 30% serologic, 38% potential, 33% tolerant. After one year, 17% resolved milk, 7% egg and 2% peanut. Rates of development of allergy were 3% for milk, 8% for egg and 3% for peanut. For those in the “potential” category at baseline, allergy was declared for 15% milk, 26% egg and 18% peanut, while tolerance was declared for 56% milk, 26% egg and 27% peanut. The one- year “allergic” rates were 42%, 31% and 4% for milk, egg and peanut, respectively. CONCLUSIONS: Applying a novel diagnostic scheme for 1 year, we observed few new allergies, but noted resolution/tolerance rates for milk that were twice those for egg.