Food allergy, dermatologic diseases, and anaphylaxisDetermination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy☆
Section snippets
Study population
Eighty-eight patients with hen's egg and 49 patients with cow's milk allergy who had undergone 2 or more DBPCFCs to cow's milk or hen's egg at our research unit were included in the study. Patients were divided into 2 groups; (1) patients with at least 2 positive DBPCFCs representing those who remained allergic, and (2) patients with an initial positive DBPCFC followed by a negative one representing those who became tolerant. DBPCFCs were performed under physician supervision as previously
Results
Twenty-eight patients who had become tolerant to hen's egg and 60 who had not were identified; for milk this was 16 who had become tolerant and 33 who had not. Table I shows the patient characteristics. Most of the patients had atopic dermatitis as their first sign of food allergy, with these symptoms usually presenting in infancy. However, the diagnosis was confirmed with DBPCFC much later, as seen from the median age of first challenge. Five of the patients in the “persistent” egg allergy
Discussion
In this study, we have shown that there is a relationship between the degree of decrease in food sIgE antibody concentrations over time and the likelihood of developing tolerance. A greater decrease in sIgE levels over a shorter period of time was indicative of a greater likelihood of developing tolerance. Of greater practical relevance to the clinician, we were able to develop estimates for the likelihood of developing tolerance based on the degree of decrease in food sIgE over a 12-month
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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.