title: Usefulness of lymphocyte stimulation test for the diagnosis of intestinal cow's milk allergy in infants.
abstract: BACKGROUND
  Bottle-fed infants sometimes develop intestinal cow's milk allergy (ICMA). Because cow's milk-specific IgE antibody (CM-IgE) levels are normal, the lymphocyte stimulation test (LST) has been proposed as an alternative diagnostic test for ICMA. The present study evaluated the diagnostic value of LST in a large number of patients with ICMA in Japan.
  
  
  METHODS
  Ninety-six infants who developed intestinal symptoms after ingestion of cow's milk formula and showed remission of symptoms after elimination of this food were enrolled as patients with probable ICMA. Seventy-two subjects with normal CM-IgE levels and a positive result in an oral food challenge test (OFCT) for cow's milk formula were diagnosed with ICMA. Another 10 infants with normal CM-IgE levels and a negative OFCT result were diagnosed with nonspecific intestinal symptoms (NIS). The status of cell-mediated immunity against cow's milk proteins was estimated by LST for κ-casein.
  
  
  RESULTS
  In the 72 patients with ICMA (38 boys and 34 girls), the median age at onset was 9 days. Sixty-two of 72 (86.1%) patients with ICMA tested positive in the LST for κ-casein. In contrast, only 2 of the 10 NIS infants tested positive. The incidence of a positive LST result was significantly higher in the ICMA group than in the NIS group (p < 0.0001). The area under the receiver-operating characteristic curve for this test was as high as 0.856.
  
  
  CONCLUSIONS
  This study strongly suggests that the LST for κ-casein is a useful diagnostic test for ICMA.
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Urushiyama 860, Shizuoka, Japan. kimurami@sch.pref.shizuoka.jp
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Kimura
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Oh
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Narabayashi
authors.forename: Tomohide
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D002364:Caseins / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000276:immunology; D008213:Lymphocyte Activation / Q000276:immunology*; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D012680:Sensitivity and Specificity
chemical_list: D002364:Caseins; D007073:Immunoglobulin E