Food allergy, dermatologic diseases, and anaphylaxis
Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy

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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.

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

References (19)

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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.

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