The natural history of milk allergy in an observational cohort

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:131

Article

Wood, Robert A.¹  Sicherer, Scott H.²  Vickery, Brian P.³  Jones, Stacie M.^4,5  Liu, Andrew H.⁶  Fleischer, David M.⁶  Henning, Alice K.⁷  Mayer, Lloyd²  Burks, A. Wesley³  Grishin, Alexander²  Stablein, Donald^4,5  Sampson, Hugh A.² 

[1] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA

[2] Mt Sinai Sch Med, Dept Pediat, New York, NY USA

[3] Univ N Carolina, Dept Pediat, Chapel Hill, NC USA

[4] Univ Arkansas Med Sci, Dept Pediat, Little Rock, AR 72205 USA

[5] Arkansas Childrens Hosp, Little Rock, AR USA

[6] Natl Jewish Hlth, Dept Pediat, Denver, CO USA

[7] EMMES Corp, Rockville, MD USA

关键词: Milk allergy;    natural history;    food allergy;    IgE;   

DOI  :  10.1016/j.jaci.2012.10.060

来源: Elsevier

【 摘 要 】

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 IgG(4) level and milk IgE/IgG(4) 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-gamma, 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. (J Allergy Clin Immunol 2013;131:805-12.)

【 授权许可】

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