Prediction of the development of tolerance to milk in children with cow's milk hypersensitivity.
OBJECTIVE
To investigate whether the development of tolerance to cow's milk (CM) by aged 4 years can be predicted with a skin prick test (SPT) and measurements of total or specific immunoglobulin E (IgE) in the serum, taken at the time of diagnosis of cow's milk hypersensitivity (CMH).


METHODS
Infants with immediate (n=95) or delayed (n=67) challenge reactions to CM were prospectively followed to aged 4 years. CMH status was assessed annually by CM challenges.


RESULTS
By aged 2, 3, and 4 years, children with delayed reactions developed tolerance to CM faster than those with immediate reactions: 64%, 92%, and 96% versus 31%, 53%, and 63%, respectively. A wheal size of <5 mm in SPT correctly identified 83% of 124 infants who developed tolerance to CM by aged 4 years, and a wheal size of >or=5 mm in SPT correctly identified 71% of 39 infants with persistent CMH. Milk-specific IgE <2 kU/L correctly identified 82% of infants who developed tolerance to CM, and milk-specific IgE >or=2 kU/L correctly identified 71% of infants with persistent CMH.


CONCLUSIONS
SPT and milk-specific IgE in the serum are useful prognostic indicators of the development of tolerance to CM in infants with CMH.
Vanto
Timo
T
Department of Pediatrics, Turku University Hospital, Turku, Finland. timo.vanto@tyks.fi
Helppilä
Sinikka
S
Juntunen-Backman
Kaisu
K
Kalimo
Kirsti
K
Klemola
Timo
T
Korpela
Riitta
R
Koskinen
Pertti
P
D000818:Animals; D002417:Cattle; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D041943:Infant Formula; D008297:Male; D016269:Milk Hypersensitivity / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D008894:Milk Proteins / Q000008:administration & dosage / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012882:Skin Tests; D030262:Soybean Proteins / Q000008:administration & dosage; D000067816:Whey Proteins
D008894:Milk Proteins; D030262:Soybean Proteins; D000067816:Whey Proteins; D007073:Immunoglobulin E