Document Detail


The natural history of milk allergy in an observational cohort.
MedLine Citation:
PMID:  23273958     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Robert A Wood; Scott H Sicherer; Brian P Vickery; Stacie M Jones; Andrew H Liu; David M Fleischer; Alice K Henning; Lloyd Mayer; A Wesley Burks; Alexander Grishin; Donald Stablein; Hugh A Sampson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-12-28
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  131     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-04-18     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  805-12     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Child, Preschool
Dermatitis, Atopic / diagnosis,  epidemiology*,  immunology
Female
Humans
Immune Tolerance*
Immunoglobulin E / blood
Immunoglobulin G / blood
Infant
Leukocytes, Mononuclear / immunology
Longitudinal Studies
Male
Milk / adverse effects,  immunology
Milk Hypersensitivity / diagnosis,  epidemiology*,  immunology
Skin Tests
Grant Support
ID/Acronym/Agency:
U01AI066560/AI/NIAID NIH HHS; U19 AI066738/AI/NIAID NIH HHS; U19AI066738/AI/NIAID NIH HHS; UL 1 RR024128/RR/NCRR NIH HHS; UL 1 TR000039/TR/NCATS NIH HHS; UL1 1TR000067/TR/NCATS NIH HHS; UL1 RR025005/RR/NCRR NIH HHS; UL1 RR025780/RR/NCRR NIH HHS; UL1 RR029887/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Immunoglobulin G; 37341-29-0/Immunoglobulin E
Comments/Corrections
Comment In:
J Allergy Clin Immunol. 2013 Mar;131(3):813-4   [PMID:  23452903 ]

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