Allergy Asthma Respir Dis.  2015 Mar;3(2):139-144. 10.4168/aard.2015.3.2.139.

Usefulness of casein specific IgE and IgG antibodies to immediate type cow's milk allergy

• Lim JH
• Jeong KU
• Lee JM
• Lee KE
• Lee S

• KMID: 2168507
• DOI: http://doi.org/10.4168/aard.2015.3.2.139

Abstract

PURPOSE
Cow's milk-specific IgE (CM-IgE) has been proposed as one of the valuable markers for diagnosis of clinical cow's milk (CM) allergy. In this study, we evaluated the additional usefulness of casein-specific IgE (casein-IgE) and IgG (casein-IgG) for the diagnosis of clinical CM allergy.
METHODS
Fifty-eight subjects, aged from 3 months to 154 months, were enrolled. Thirty-four patients showed immediate-type of clinical CM allergy, and 24 patients were atopic controls. The serum levels of CM-IgE, casein-IgE, and casein-IgG were measured. Patients were divided into 2 groups: those aged under 12 months and those aged 12 months or over. The diagnostic values of each antibody were analyzed and compared using the Mann-Whitney U-test and receiver operating characteristic curves.
RESULTS
CM allergy had significantly higher levels of CM-IgE and casein-IgE, and lower levels of casein-IgG/IgE ratio when compared to atopic controls in both age groups (P<0.05). CM-IgE and casein-IgE were shown to be better predictive markers for immediate-type CM allergy in patients under 12 months, while casein-IgG/IgE ratio was a more useful marker in those aged 12 months or over. Considering 100% positive predictive values, cutoff points were 1.04 kU/L for CM-IgE, 0.11 kU/L for casein-IgE, 19.5 for casein-IgG/IgE ratio in patients aged under 12 months, and 7.1 kU/L for CM-IgE, 1.41 kU/L for casein-IgE, 12.51 for casein-IgG/IgE ratio in those aged 12 months or over.
CONCLUSION
CM-IgE, casein-IgE, and casein-IgG/IgE ratio are useful markers for predicting immediate-type CM allergy. Further studies are needed on diagnostic decision points for CM allergy using combination of cutoff values of these 3 markers.

Keyword

Milk hypersensitivity; Caseins; Immunoglobulin E; Immunoglobulin G; Anaphylaxis

MeSH Terms

Anaphylaxis
Antibodies*
Caseins*
Diagnosis
Humans
Hypersensitivity
Immunoglobulin E*
Immunoglobulin G*
Milk
Milk Hypersensitivity*
ROC Curve
Antibodies
Caseins
Immunoglobulin E
Immunoglobulin G

Figure

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  Fig. 1 Receiver operating characteristic curve represent sensitivity and specificity of cow's milk and casein antibodies for diagnosing clinical cow's milk allergy aged less than 12 months (A), aged 12 months or over 12 months (B).

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  Fig. 2 Comparison of sensitivity, specificity, positive predictive value and negative predictive value of cow's milk and casein antibodies aged less than 12 months (A), aged 12 months or over 12 months (B).

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