IgE-mediated Cow's Milk Allergy in Brazilian Children: Outcomes of Oral Food Challenge

Overview

Journal World Allergy Organ J

Specialty Allergy & Immunology

Date 2023 May 30

PMID 37251812

Authors

Bruna Pultrini Aquilante

Ana Paula Beltran Moschione Castro

Glauce Hiromi Yonamine

Mayra de Barros Dorna

Mariana Fernandes Barp

Tatiana Paskin da Rosa Martins

Antonio Carlos Pastorino

Affiliations

Soon will be listed here.

Abstract

Background: Oral food challenge (OFC) is useful for diagnosing food allergies and assessing tolerance, but severe reactions may occur during the procedure.

Objective: To characterize the frequency and severity of reactions during cow's milk (CM) OFCs.

Methods: A cross-sectional study was conducted to analyze the outcome of cow's milk oral food challenges (CMOFCs) performed to confirm IgE-mediated CM allergy or to assess food tolerance. CM was given first as baked milk (BM), followed by whole CM if there was no prior reaction to BM. An OFC was considered positive if IgE-mediated symptoms developed up to 2 h after ingestion. Symptoms were described and variables including age at OFC, prior anaphylaxis, other atopic diseases, and skin test results were compared according to the OFC outcomes.

Results: A total of 266 CMOFCs were performed, including 159 patients with a median age of 6.3 years old. One hundred thirty-six tests were positive and 62 resulted in anaphylaxis. Thirty-nine anaphylactic reactions were observed up to 30 min after the first dose. Severe anaphylaxis (cardiovascular and/or neurological involvement) was reported in 5 tests. A second dose of epinephrine was required in 3 tests, and 1 presented a biphasic response. Younger patients had a higher risk of anaphylaxis during baked milk oral food challenge (BMOFC) (p = 0.009). The frequency of anaphylaxis was higher in patients submitted to BM (p = 0.009).

Conclusions: Anaphylaxis is a known complication of CMOFCs even when there is no prior anaphylaxis or when conducted with baked products. This study reinforces the importance of conducting OFC in appropriate settings with a well-trained team.

Citing Articles

The baked side: Cow's milk and egg protein threshold dose distributions in children reacting to baked milk and baked egg.

Valluzzi R, Riccardi C, Urbani S, Ursi D, Zavettieri D, Di Girolamo F World Allergy Organ J. 2025; 18(1):101012.

PMID: 39791114 PMC: 11714411. DOI: 10.1016/j.waojou.2024.101012.

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