title: The natural history of milk allergy in an observational cohort.
abstract: 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 IgG4 level and milk IgE/IgG4 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-γ, 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.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md., USA. rwood@jhmi.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wood
authors.forename: Scott H
authors.initials: SH
authors.lastname: Sicherer
authors.forename: Brian P
authors.initials: BP
authors.lastname: Vickery
authors.forename: Stacie M
authors.initials: SM
authors.lastname: Jones
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Liu
authors.forename: David M
authors.initials: DM
authors.lastname: Fleischer
authors.forename: Alice K
authors.initials: AK
authors.lastname: Henning
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mayer
authors.forename: A Wesley
authors.initials: AW
authors.lastname: Burks
authors.forename: Alexander
authors.initials: A
authors.lastname: Grishin
authors.forename: Donald
authors.initials: D
authors.lastname: Stablein
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008137:Longitudinal Studies; D008297:Male; D008892:Milk / Q000009:adverse effects / Q000276:immunology; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D012882:Skin Tests
chemical_list: D007074:Immunoglobulin G; D007073:Immunoglobulin E