Liat Nachshon, Michael R Goldberg, Naama Epstein-Rigbi, Yitzhak Katz, Arnon Elizur
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引用次数: 0
Abstract
Background: Resolution rates of IgE-mediated cow's milk allergy (IgE-CMA) by age 5 years, and risk factors for its persistence were previously described.
Objective: To extend follow-up until the end of adolescence.
Methods: An extension study of 23 of 54 patients diagnosed with IgE-CMA from a population-based study of 13,019 newborns, who remained allergic at age 5 years. Patients were examined at age 17 and their history reviewed. Resolution was determined by regular milk consumption without adverse reactions, or a negative oral food challenge (OFC). Allergy was defined by a recent objective reaction to milk and a positive skin prick test (SPT), or by sensitization ≥95% PPV to milk. Risk factors for persistence at age 17 were examined in the entire cohort.
Results: Of the 23 patients followed, 8/23 (35%) had spontaneous resolution, and 15 had persistent IgE-CMA. Overall, 39 (72.2%) of the 54 patients initially diagnosed with IgE-CMA had spontaneous resolution by age 17. Risk factors for IgE-CMA persistence at age 17 years included SPT >6 mm at time of diagnosis (p=0.03), no cow's milk formula feeding in the nursery (p=0.008), and wheezing on diagnostic OFC/initial reaction to milk (p=0.04). Seven patients experienced objective reactions after age 5 years. These patients had more wheezing (p=0.045) or anaphylaxis (p=0.02) on diagnostic OFC/initial reaction and more current asthma (p=0.007).
Conclusion: Significant rate of spontaneous resolution of IgE-CMA still occurs beyond age 5 and few patients with IgE-CMA, mostly asthmatics, experience objective reactions by early adulthood. This should be considered in the treatment approach of IgE-CMA patients.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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