TY - JOUR
T1 - Long-Term Outcome of IgE-Mediated Cow's Milk Allergy and Risk Factors for Persistence
AU - Nachshon, Liat
AU - Goldberg, Michael R.
AU - Epstein-Rigbi, Naama
AU - Katz, Yitzhak
AU - Elizur, Arnon
N1 - Publisher Copyright:
© 2024 American Academy of Allergy, Asthma & Immunology
PY - 2025/2
Y1 - 2025/2
N2 - Background: Resolution rates of IgE-mediated cow's milk allergy (IgE-CMA) by age 5 years and risk factors for its persistence were previously described. Objective: To extend follow-up until the end of adolescence. Methods: This is an extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 years, and their history was reviewed. Resolution was determined by regular milk consumption without adverse reactions or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% positive predictive value (PPV) to milk. Risk factors for persistence at age 17 years were examined in the entire cohort. Results: Of the 23 patients followed, 8 (35%) had spontaneous resolution and 15 had persistent IgE-CMA. Overall, 39 of the 54 patients (72.2%) initially diagnosed with IgE-CMA had spontaneous resolution by age 17 years. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at the time of diagnosis (P = .03), no cow's milk formula feeding in the nursery (P = .008), and wheezing on diagnostic OFC/initial reaction to milk (P = .04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (P = .045) or anaphylaxis (P = .02) on diagnostic OFC/initial reaction and more current asthma (P = .007). Conclusions: Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 years, and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of patients with IgE-CMA.
AB - Background: Resolution rates of IgE-mediated cow's milk allergy (IgE-CMA) by age 5 years and risk factors for its persistence were previously described. Objective: To extend follow-up until the end of adolescence. Methods: This is an extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 years, and their history was reviewed. Resolution was determined by regular milk consumption without adverse reactions or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% positive predictive value (PPV) to milk. Risk factors for persistence at age 17 years were examined in the entire cohort. Results: Of the 23 patients followed, 8 (35%) had spontaneous resolution and 15 had persistent IgE-CMA. Overall, 39 of the 54 patients (72.2%) initially diagnosed with IgE-CMA had spontaneous resolution by age 17 years. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at the time of diagnosis (P = .03), no cow's milk formula feeding in the nursery (P = .008), and wheezing on diagnostic OFC/initial reaction to milk (P = .04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (P = .045) or anaphylaxis (P = .02) on diagnostic OFC/initial reaction and more current asthma (P = .007). Conclusions: Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 years, and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of patients with IgE-CMA.
KW - Adverse reactions
KW - Asthma
KW - Milk allergy
KW - Oral Immunotherapy
KW - Wheezing
UR - http://www.scopus.com/inward/record.url?scp=85209999859&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2024.10.026
DO - 10.1016/j.jaip.2024.10.026
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C2 - 39486514
AN - SCOPUS:85209999859
SN - 2213-2198
VL - 13
SP - 369-377.e3
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 2
ER -