Cow’s milk allergy skin tests: fresh milk, commercial extracts, or both?

Allergy, Asthma & Clinical Immunology

Research

Anat Cohen-Engler¹  Keren Meir-Shafrir¹  Ronit Confino-Cohen²  Yossi Rosman²  Idit Lachover-Roth²  Tzipi Hornik-Lurie³  Nadav Giorno⁴ 

[1] Allergy and Clinical Immunology Unit, Meir Medical Center, 44261, Kfar Saba, Israel;Allergy and Clinical Immunology Unit, Meir Medical Center, 44261, Kfar Saba, Israel;Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;Meir Medical Center, Kfar Saba, Israel;Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;

关键词: Food allergy;    Skin prick test (SPT);    Commercial extracts;    Fresh food;    Cow’s milk allergy;   

DOI  :  10.1186/s13223-023-00763-w

 received in 2022-12-03, accepted in 2023-01-11,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe diagnosis of food allergy is based on a history of immediate allergic reaction following food ingestion, and skin prick test (SPT) demonstrating sensitization with commercial extracts (CE) or fresh food (FF). For most food allergens, the SPT with FF is considered more accurate and predictive. Regarding cow’s milk, the results are inconclusive. This retrospective study aimed to evaluate the accuracy of SPT with fresh milk compared to CE (cow’s milk and casein) for evaluation of cow’s milk allergy (CMA).MethodsThis study summarized the medical records of children, diagnosed with CMA. The data include demographics, skin tests and oral food challenge results, as well as atopic comorbidities.ResultsRecords of 698 patients with the diagnosis of CMA were reviewed, 388 fulfilled the inclusion criteria. Overall, 134 patients (34.54%) had an additional atopic disease. The SPT wheal size with fresh milk was significantly larger than with CE (cow's milk and casein) at first evaluation or before oral food challenge (OFC). Combination of SPT results (CE and FF) gave the maximal odds ratio for reaction during OFC and SPT with fresh milk alone gave the minimal OR (34.18 and 4.74, respectively).ConclusionsSPT with CE for CMA evaluation is more reliable than SPT performed with fresh milk. In patients suspected of having IgE-mediated CMA, before deciding on performing OFC, it is advised to perform SPT with at least two different extracts, and always include casein. Fresh milk can serve as a backup if commercial extracts are not available. In cases that the SPT with fresh milk is 3 mm or less, there is 93.3% chance that the OFC will pass without reaction.Trial registration This study protocol was reviewed and approved by the Ethics Committee of Meir Medical Center, IRB Number 0083-18 MMC.

【 授权许可】

CC BY   
© The Author(s) 2023

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