Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy - 25/08/11
Reprint requests: Hugh A. Sampson, MD, Department of Pediatrics, Box 1198, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574.New York, NY, and Uppsala and Stockholm, Sweden
Abstract |
Background |
The majority of children with cow's milk and hen's egg allergy develop clinical tolerance with time. However, there are no good indices to predict when and in whom this occurs.
Objective |
The aim of this study was to determine if monitoring food specific IgE levels over time could be used as a predictor for determining when patients develop clinical tolerance.
Methods |
Eighty-eight patients with hen's egg and 49 patients with cow's milk allergy who underwent repeated double-blind, placebo-controlled food challenges were included in the study. Using the Pharmacia CAP-System FEIA, specific IgE (sIgE) levels to cow's milk and hen's egg were retrospectively determined from stored serum samples obtained at the time of the food challenges. Logistic regression was used to evaluate the relationship between tolerance development and the decrease in sIgE levels over a specific time period between the two challenges.
Results |
Twenty-eight of the 66 egg-allergic and 16 of the 33 milk-allergic patients lost their allergy over time. For egg, the decrease in sIgE levels (P=.0014) was significantly related to the probability of developing clinical tolerance, with the duration between challenges having an influence (P=.06). For milk there also was a significant relationship between the decrease in sIgE levels (P=.0175) and the probability of developing tolerance to milk but no significant contribution with regard to time. Stratification into 2 age groups, those below 4 years of age and those above 4 years of age at time of first challenge, had an effect, with the younger age group being more likely to develop clinical tolerance in relation to the rate of decrease in sIgE. The median food sIgE level at diagnosis was significantly less for the group developing “tolerance” to egg (P < .001), and a similar trend was seen for milk allergy (P=.06). Using these results, we developed a model for predicting the likelihood of developing tolerance in milk and egg allergy based on the decrease in food sIgE over time.
Conclusion |
We found that the rate of decrease in food sIgE levels over time was predictive for the likelihood of developing tolerance in milk and egg allergy. Using the likelihood estimates from this study could aid clinicians in providing prognostic information and in timing subsequent food challenges, thereby decreasing the number of premature and unnecessary double-blind, placebo-controlled food challenges.
Le texte complet de cet article est disponible en PDF.Keywords : Food allergy, egg allergy, milk allergy, CAP System FEIA, quantitative IgE, diagnostic test, natural history
Abbreviations : DBPCFC, sIgE
Plan
 | This study was funded by a grant from the NIH, NIAID AI44236 and DRR M01-RR-00071. The reagents were provided by Pharmacia AB Diagnostics (Uppsala, Sweden). Disclosure of potential conflict of interest: L.P.C. Shek—none disclosed. L. Soderstrom is employed by Pharmacia Diagnostics AB. K. Beyer—none disclosed. S. Ahlstedt is employed by Pharmacia Diagnostics AB. H.A. Sampson is a consultant to Seer Pharmaceuticals, Inc, receives grants/research support from NIAD, Pharmacia Diagnostics, AB, Uppsala, Sweden, and is employed by Mount Sinai School of Medicine. |
Vol 114 - N° 2
P. 387-391 - août 2004 Retour au numéro
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