title: Usefulness of nBos d 4, 5 and nBos d 8 Specific IgE Antibodies in Cow's Milk Allergic Children.
abstract: OBJECTIVE
  The aim of study was to assess the value of recombinants in predicting the degree of symptoms in children with and without anaphylaxis to cow's milk.
  
  
  METHODS
  The study included 79 children (70±40 months) referred to the Allergological Unit of the Pediatric Department between the years 2008-2012. Group A was composed of 17 children (78±49.6 months) with anaphylaxis after ingestion of milk. Group B was composed of 62 children (73.1±38.6 months) without a history of anaphylaxis, but with less severe symptoms (gastrointestinal and/or skin symptoms). All patients from Group B had a positive open challenge with cow's milk. All patients underwent an allergic evaluation and blood samples were collected to test for IgE to recombinans of milk (nBos d 4, 5, 8).
  
  
  RESULTS
  A significant difference in nBos d 8 emerged with higher levels in Group A (median [IQR]=2.80 [0.91-16.1]) than B (0.65 [0.24-1.67]; P=0.006), whereas there were no statistically significant differences for nBos d 4 and 5. The recombinants' sum was higher in Group A than B: 8.39 [2.72-41.39] vs 3.04 [1.85-7.31] kUA/L; P=0.044. The recombinant nBos d 8 was superior to the other recombinants in identifying children at risk for anaphylaxis, with an area under the curve of 0.718 (95% CI, 0.57-0.86, P=0.006). Considering a cutoff of 1.8 kUA/L, nBos d 8 had the most favorable sensitivity and specificity ratio (sensitivity=0.65, specificity=0.77) with an odd ratio of 6.02 (95% C.I: 1.89-19.23).
  
  
  CONCLUSIONS
  This study suggested 2 phenotypes of allergic children, "high-anaphylaxis-risk" and "milder-risk". These types can be differentiated through measuring the level of IgE to nBos d 8.
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Cingolani
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Di Pillo
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Cerasa
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rapino
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Nicola Pietro
authors.initials: NP
authors.lastname: Consilvio
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Attanasi
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scaparrotta
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: M Loredana
authors.initials: ML
authors.lastname: Marcovecchio
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Angelika
authors.initials: A
authors.lastname: Mohn
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarelli
keywords: allergy; child; milk; recombinant proteins; symptoms