Cow’s milk specific-IgE in infants younger than one year of age with atopic dermatitis

Nattapol Thamsakulsiri; Srisupalak Singalavanija; Wanida Limpongsanurak

Authors

Nattapol Thamsakulsiri DIVISION OF DERMATOLOGY, DEPARTMENT OF PEDIATRICS, QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEALTH, BANGKOK, THAILAND
Srisupalak Singalavanija DIVISION OF DERMATOLOGY, DEPARTMENT OF PEDIATRICS, QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEALTH, BANGKOK, THAILAND
Wanida Limpongsanurak DIVISION OF DERMATOLOGY, DEPARTMENT OF PEDIATRICS, QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEALTH, BANGKOK, THAILAND

Keywords:

Atopic dermatitis, Cow’s milk specific IgE

Abstract

Backgrounds: Cow's milk is one of the most common food allergens in infants with moderate to severe atopic dermatitis (AD). Several studies had evaluated the role of cow’s milk specific-IgE (CM IgE) test, but there is still controversy of the cut-off level.

Objective: To determine the prevalence and the role of CM IgE for diagnosis of cow’s milk protein allergy (CMPA) in infants with moderate to severe AD.

Materials and Methods: Serum CM IgE was measured in 87 infants younger than one year of age with moderate to severe AD (SCORAD > 15). After 2 weeks of treatment with topical corticosteroid, emollient and antihistamine, extensively hydrolyzed or amino acid based formula was introduced in the patients whose skin lesions did not improve. Oral challenge test was performed in the patients who were suspected to have cow’s milk protein allergy to confirm the diagnosis. All of the patients were assessed of skin lesions at 3 and 6 months after diagnosis.

Results: Of 87 patients, 39 patients (44.8%) and 48 patients (55.2%) were diagnosed as CMPA and without CMPA, respectively. The prevalence of the patients with CM IgE ≥ 0.35 KUA/L were 31%. Mean serum CM IgE in the patients with CMPA was significantly higher than the patients without CMPA (1.4 ± 2.9 (range 0.02 – 13.4) KUA/L vs 0.2 ± 0.3 (range 0.01 – 1.37) KUA/L, p = 0.01). Serum CM IgE of the patients with CMPA < 0.35 KUA/L, 0.35 – 4.9 KUA/L, ≥ 5 KUA/L was found in 20 patients (51.3%), 14 patients (35.9%) and 5 patients (12.8%), respectively. In patients with CMPA were associated with early age of onset, greater severity and more CM IgE level than the patients without CMPA.

Conclusion: High level of serum CM IgE is hepful for diagnosis of CMPA in moderate to severe atopic patients. However, serum CM IgE < 0.35 KUA/L can not exclude CMPA. Elimination of cow’s milk and oral challenge test should be performed to confirm the diagnosis.

References

Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermati¬tis: evaluation of 113 patients. J Pediatr 1985;107:669-75.

Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic der¬matitis. Pediatrics 1998;101:e8.

Eigenmann PA, Calza AM. Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol 2000;11:95-100.

Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asth¬ma Immunol 2002;89:33-7.

Novembre E, Vierucci A. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy 2001;56:105-8.

Tempark T. Specific IgE (IgE-food sensitization) in children with atopic dermatitis. A thesis submitted in partial fulfillment of the requirements for the Diploma of the Clinical Fellowship in Pediatric Dermatology, Royal College of Pediatrician of Thailand 2008:16-21.

Hanifin JM. Defining atopic dermatitis and assessing its impact: seeking simplified, inclusive and internationally applicable criteria. Paper presented at the international symposium on atopic dermatitis, National Eczema Association for Science and Education Portland, Oregon September 6-9, 2001.

Stalder JF, Atherton DJ, Bieber T, et al. (Consensus Report of the European Task Force on Atopic Dermatitis). Severity scoring of atopic dermatitis: the SCORAD index Dermatology 1993; 186: 23-31.

Greenhawt M. The role of food allergy in atopic dermatitis. Allergy Asthma Proc 2010;31:392-7.

Suh KY. Food allergy and atopic dermatitis: separating fact from fiction. Semin Cutan Med Surg 2010;29:72-8.

Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K, et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 2007;62:723-8.

Kim HO, Cho SI, Kim JH, Chung BY, Cho HJ, Park CW, et al. Food hypersensitivity in patients with childhood atopic dermatitis in Korea. Ann Dermatol. 2013;25(2):196-202.

Pourpak Z, Farhoudi A, Mahmoudi M, Movahedi M, Ghargozlou M, Kazemnejad A, et al. The role of cow milk allergy in increasing the severity of atopic dermatitis. Immunol Invest. 2004;33(1):69-79.

Lee JM, Yoon JS, Jeon SA, Lee SY. Sensitization patterns of cow’s milk and major components in young children with atopic dermatitis. Asia Pac Allergy 2013;3:179-85.

Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol 2010;125(2 suppl 2):S116-25.

Hill DJ, Hosking CS, de Benedictis FM, Oranje AP, Diepgen TL, Bauchau V, et al. Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy 2007;38:161–8.

Roehr CC, Reibel S, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. et al. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol 2001;107:548-53.

Majamaa H, Moisio P, Holm K, Kautiainen H, Turjanmaa K. Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE. Allergy 1999;54:346-51.

Vanto T, Juntunen-Backman K, Kalimo K, Klemola T, Koivikko A, Koskinen P, et al. The patch test, skin prick test, and serum milk-specific IgE as diagnostic tools in cow's milk allergy in infants. Allergy 1999;54:837-42.

Saarinen KM, Suomalainen H, Savilahti E. Diagnostic value of skin-prick and patch tests and serum eosinophil cationic protein and cow's milk-specific IgE in infants with cow's milk allergy. Clin Exp Allergy 2001;31:423–9.

García-Ara C, Boyano-Martínez T, Díaz-Pena JM, Martín-Muñoz F, Reche-Frutos M, Martín-Esteban M, et al. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant. J Allergy Clin Immunol 2001;107(1):185-90.

Hill DJ, Sporik R, Thorburn J, Hosking CS. The association of atopic dermatitis in infancy with immunoglobulin E food sensitization. J Pediatr 2000;137:475-9.

Hill DJ, Hosking CS. Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol 2004;15:421-7.

Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999;104:114–22.

Niggemann B, Reibel S, Roehr CC, Felger D, Ziegert M, Sommerfeld C, et al. Predictors of positive food challenge outcome in non-IgE-mediated reactions to food in children with atopic dermatitis. J Allergy Clin Immunol 2001;108:1053–8.

Weidinger S, Illig T, Baurecht H, Irvine AD, Rodriguez E, Diaz-Lacava A, et al. Loss-of-function variations within the filaggrin gene predisposes for atopic dermatitis with allergic sensitizations. J Allergy Clin Immunol 2006;118:214–9.

Suh J, Lee H, Lee JH, Cho J, Yu JS, Kim J et al. Natural course of cow’s milk allergy in children with atopic dermatitis. J Korean Med Sci 2011;26:1152-8.