Allergy Asthma Immunol Res.  2015 Jul;7(4):332-338. 10.4168/aair.2015.7.4.332.

Diagnostic Decision Points of Specific IgE Concentrations in Korean Children With Egg and Cow's Milk Allergies

• Kim J
• Kim HY
• Park MR
• Choi J
• Shim JY
• Kim MJ
• Han Y
• Ahn K

• KMID: 2166680
• DOI: http://doi.org/10.4168/aair.2015.7.4.332

Abstract

PURPOSE
The purpose of this study was to evaluate the utility of specific IgE (sIgE) concentrations for the diagnosis of immediate-type egg and cow's milk (CM) allergies in Korean children and to determine the optimal cutoff levels.
METHODS
In this prospective study, children > or =12 months of age with suspected egg or CM allergy were enrolled. Food allergy was diagnosed by an open oral food challenge (OFC) or through the presence of a convincing history after ingestion of egg or CM. The cutoff levels of sIgE for egg white (EW) and CM were determined by analyzing the receiver operating characteristic curves.
RESULTS
Out of 273 children, 52 (19.0%) were confirmed to have egg allergy. CM allergy was found in 52 (23.1%) of 225 children. The EW-sIgE concentration indicating a positive predictive value (PPV) of >90% was 28.1 kU/L in children <24 months of age and 22.9 kU/L in those > or =24 months of age. For CM-sIgE, the concentration of 31.4 kU/L in children <24 months of age and 10.1 kU/L in those > or =24 months of age indicated a >90% PPV. EW-sIgE levels of 3.45 kU/L presented a negative predictive value (NPV) of 93.6% in children <24 months of age, while 1.80 kU/L in those > or =24 months of age presented a NPV of 99.2%. The CM-sIgE levels of 0.59 kU/L in children <24 months of age and 0.94 kU/L in those > or =24 months of age showed NPVs of 100% and 96.9%.
CONCLUSIONS
Our results indicate that different diagnostic decision points (DDPs) of sIgE levels should be used for the diagnosis of egg or CM allergy in Korean children. The data also suggest that DDPs with high PPV and high NPV are useful for determining whether OFC is required in children with suspected egg or CM allergy.

Keyword

Egg allergy; food allergy; milk allergy; specific IgE

MeSH Terms

Child*
Diagnosis
Eating
Egg Hypersensitivity
Egg White
Food Hypersensitivity
Humans
Hypersensitivity
Immunoglobulin E*
Milk
Milk Hypersensitivity*
Ovum*
Prospective Studies
ROC Curve
Immunoglobulin E

Figure

• 

  Fig. 1 Flowchart of study population.

• 

  Fig. 2 Comparison of specific IgE levels between positive and negative oral food challenge (OFC) groups. (A) All children for hen's egg challenge; (B) those <24 months of age for hen's egg challenge; (C) those ≥24 months of age for hens' egg challenge; (D) all children for cow's milk challenge; (E) those <24 months of age for cow's milk challenge; (F) those ≥24 months of age for cow's milk challenge. EW, egg white; CM, cow's milk. Each box plot indicates an interquartile range (IQR) with median, upper, and lower whiskers; upper and lower boundaries (3rd quartile/1st quartile ±1.5 IQR). The blue and red boxes represent patients showing positive and negative OFC results.

• 

  Fig. 3 Performance characteristics of optimal cutoff values of egg white specific IgE established by ROC analysis. (A) All children; (B) those <24 months of age; (C) those ≥24 months of age.

• 

  Fig. 4 Performance characteristics of optimal cutoff values of cow's milk specific IgE established by ROC analysis. (A) All children; (B) those <24 months of age; (C) those ≥24 months of age.

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