The natural history of milk allergy in an observational cohort - 27/02/13
, Scott H. Sicherer, MD b, , Brian P. Vickery, MD c, Stacie M. Jones, MD d, Andrew H. Liu, MD e, David M. Fleischer, MD e, Alice K. Henning, MS f, Lloyd Mayer, MD b, A. Wesley Burks, MD c, Alexander Grishin, PhD b, Donald Stablein, PhD d, Hugh A. Sampson, MD bCorresponding author: Robert A. Wood, MD, CMSC 1102, Johns Hopkins Hospital, 600 North Wolfe St, Baltimore, MD 21287.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.
Le texte complet de cet article est disponible en PDF.Key words : Milk allergy, natural history, food allergy, IgE
Abbreviations used : AD, Ct, SPT
Plan
| Supported by National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases grants U19AI066738 and U01AI066560. The project was also supported by grant nos. UL1 RR025780 (National Jewish), UL1 1TR000067 (Mount Sinai), UL 1 TR000039 (Arkansas), UL 1 RR024128 (North Carolina) and UL1 RR 025005 (Johns Hopkins) from the National Center for Research Resources (NCRR), a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH. |
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| Disclosure of potential conflict of interest: R. A. Wood has consultant arrangements with the Asthma and Allergy Foundation of America, is employed by Johns Hopkins University, has received research support from the National Institutes of Health (NIH), and receives royalties from UpToDate. S. H. Sicherer has received grants from the NIH/National Institute of Allergy and Infectious Diseases (NIAID) and has consultant arrangements with the Food Allergy Initiative. B. P. Vickery has received grants and travel support from the NIH/NIAID; has consultant arrangements with Mead Johnson; has received grants from the NIH/NIAID, the Thrasher Research Fund, the American Lung Association, and Cephalon. S. M. Jones is a member of the medical advisory board for the Food Allergy & Anaphylaxis Network (FAAN); has received grants from the NIH, the FAAN, and the National Peanut Board; has received payment for lectures, including service on speakers’ bureaus, from Abbott Nutrition International, the Kentucky Society for Allergy, Asthma & Immunology, the New England Allergy Society, the American College of Allergy, Asthma & Immunology, Indiana University Medical School and Riley Children’s Hospital, the Spanish Society of Allergy & Clinic Immunology, and the Oregon Allergy Asthma & Immunology Society; has served on the NIAID Safety Monitoring Committee, the Arkansas Medicaid Drug Review Committee, and the NIAID Study Section. D. M. Fleischer has received grants from the NIH/NIAID, has consultant arrangements with Sanofi-Aventis, and receives royalties from UpToDate. A. K. Henning has received grants from the NIH. A. W. Burks has received grants or has grants pending from the NIH, the Department of Defense, and the Wallace Research Foundation; is a board member for the American Academy of Allergy, Asthma & Immunology, the NIH Hypersensitivity, Autoimmune, and Immune-mediated Disease Study Section, the Journal of Allergy and Clinical Immunology, and the US Food and Drug Administration; is on advisory boards for ExploraMed Development, LLC, the FAAN, and ActoGeniX; has consultant arrangements with Merck & Co, Novartis Pharma AG, the Dannon Company, McNeill Nutritionals, and Schering-Plough; is employed by UNC Children’s Hospital and Duke University; has received payment for lectures from Mylan Specialty; has received royalties from UpToDate; has received payment for development of educational presentations from Current Views; has stock/stock options in Allertein, Mastcell Pharmaceuticals, and Dow AgroSciences; and has received travel expenses from the European Academy of Allergy & Clinical Immunology. A. Grishin has received grants from the NIH/NIAID and has consultant arrangements with Allertein Therapeutics. D. Stablein has received grants from the NIH. H. A. Sampson has received grants from the NIH and the NIAID, has received travel support from the NIAID, is on the Danone Scientific Advisory Board, has consultant arrangements with Allertein Therapeutics and the Food Allergy Initiative, is employed by Mount Sinai Medical School, and has received royalties from Elsevier-Wiley and UpToDate. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 131 - N° 3
P. 805 - mars 2013 Retour au numéro
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