{"title":"完全避免患者的低剂量口服牛奶挑战结果：日本的一项多中心研究。","authors":"Yuki Sakaguchi, Ken-Ichi Nagakura, Kyohei Takahashi, Hiroaki Taniguchi, Mika Ogata, Ikuo Okafuji, Yumi Koike, Yasusuke Kawada, Komei Ito, Mizuho Nagao, Katsushi Miura, Tatsuki Fukuie, Sakura Sato, Noriyuki Yanagida, Motohiro Ebisawa","doi":"10.1111/pai.70105","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Few studies have reported significant risk factors for allergic symptoms during low-dose (1-3 mL) cow's milk (CM) oral food challenges (OFCs). We investigated patients from multiple centers in Japan to identify high-risk, low-dose CM OFCs and conducted these tests at allergy-specialized facilities.</p><p><strong>Methods: </strong>We retrospectively collected the results of the first low-dose CM OFCs performed at 10 hospitals in Japan between January and December 2019. All patients completely eliminated CM and underwent low-dose CM OFCs. The risk factors for positive OFC and anaphylaxis were analyzed using logistic regression analyses.</p><p><strong>Results: </strong>We included 244 patients (median age: 2.5 years). The median level of CM-specific immunoglobulin E (sIgE) was 13.1 (interquartile range: 3.7-45.6) kU<sub>A</sub>/L. The rates of positive and anaphylaxis among positive for CM OFCs were 44% and 19%, respectively. Multivariate analyses that separately analyzed each sIgE identified high CM sIgE and casein sIgE levels as significant risk factors for OFC positivity (both p < .001). The optimal cut-off values for CM and casein sIgE levels to predict positive CM OFCs from receiver operating characteristic curves were 5.4 and 7.3 kU<sub>A</sub>/L, respectively. When CM sIgE or casein sIgE levels were ≥10.9 kU<sub>A</sub>/L or ≥ 11.5 kU<sub>A</sub>/L, they corresponded to 5% predicted probabilities of anaphylaxis. Furthermore, when their levels are ≥100 kU<sub>A</sub>/L, the predicted probabilities increase to 20%.</p><p><strong>Conclusion: </strong>CM and casein sIgE levels should be considered when predicting low-dose CM OFC outcomes.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 5","pages":"e70105"},"PeriodicalIF":4.5000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Low-dose oral cow's milk challenge outcome for patients on complete avoidance: A multicenter study in Japan.\",\"authors\":\"Yuki Sakaguchi, Ken-Ichi Nagakura, Kyohei Takahashi, Hiroaki Taniguchi, Mika Ogata, Ikuo Okafuji, Yumi Koike, Yasusuke Kawada, Komei Ito, Mizuho Nagao, Katsushi Miura, Tatsuki Fukuie, Sakura Sato, Noriyuki Yanagida, Motohiro Ebisawa\",\"doi\":\"10.1111/pai.70105\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Few studies have reported significant risk factors for allergic symptoms during low-dose (1-3 mL) cow's milk (CM) oral food challenges (OFCs). We investigated patients from multiple centers in Japan to identify high-risk, low-dose CM OFCs and conducted these tests at allergy-specialized facilities.</p><p><strong>Methods: </strong>We retrospectively collected the results of the first low-dose CM OFCs performed at 10 hospitals in Japan between January and December 2019. All patients completely eliminated CM and underwent low-dose CM OFCs. The risk factors for positive OFC and anaphylaxis were analyzed using logistic regression analyses.</p><p><strong>Results: </strong>We included 244 patients (median age: 2.5 years). The median level of CM-specific immunoglobulin E (sIgE) was 13.1 (interquartile range: 3.7-45.6) kU<sub>A</sub>/L. The rates of positive and anaphylaxis among positive for CM OFCs were 44% and 19%, respectively. Multivariate analyses that separately analyzed each sIgE identified high CM sIgE and casein sIgE levels as significant risk factors for OFC positivity (both p < .001). The optimal cut-off values for CM and casein sIgE levels to predict positive CM OFCs from receiver operating characteristic curves were 5.4 and 7.3 kU<sub>A</sub>/L, respectively. When CM sIgE or casein sIgE levels were ≥10.9 kU<sub>A</sub>/L or ≥ 11.5 kU<sub>A</sub>/L, they corresponded to 5% predicted probabilities of anaphylaxis. Furthermore, when their levels are ≥100 kU<sub>A</sub>/L, the predicted probabilities increase to 20%.</p><p><strong>Conclusion: </strong>CM and casein sIgE levels should be considered when predicting low-dose CM OFC outcomes.</p>\",\"PeriodicalId\":520742,\"journal\":{\"name\":\"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology\",\"volume\":\"36 5\",\"pages\":\"e70105\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1111/pai.70105\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1111/pai.70105","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Low-dose oral cow's milk challenge outcome for patients on complete avoidance: A multicenter study in Japan.
Background: Few studies have reported significant risk factors for allergic symptoms during low-dose (1-3 mL) cow's milk (CM) oral food challenges (OFCs). We investigated patients from multiple centers in Japan to identify high-risk, low-dose CM OFCs and conducted these tests at allergy-specialized facilities.
Methods: We retrospectively collected the results of the first low-dose CM OFCs performed at 10 hospitals in Japan between January and December 2019. All patients completely eliminated CM and underwent low-dose CM OFCs. The risk factors for positive OFC and anaphylaxis were analyzed using logistic regression analyses.
Results: We included 244 patients (median age: 2.5 years). The median level of CM-specific immunoglobulin E (sIgE) was 13.1 (interquartile range: 3.7-45.6) kUA/L. The rates of positive and anaphylaxis among positive for CM OFCs were 44% and 19%, respectively. Multivariate analyses that separately analyzed each sIgE identified high CM sIgE and casein sIgE levels as significant risk factors for OFC positivity (both p < .001). The optimal cut-off values for CM and casein sIgE levels to predict positive CM OFCs from receiver operating characteristic curves were 5.4 and 7.3 kUA/L, respectively. When CM sIgE or casein sIgE levels were ≥10.9 kUA/L or ≥ 11.5 kUA/L, they corresponded to 5% predicted probabilities of anaphylaxis. Furthermore, when their levels are ≥100 kUA/L, the predicted probabilities increase to 20%.
Conclusion: CM and casein sIgE levels should be considered when predicting low-dose CM OFC outcomes.
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