Asia Pac Allergy.  2013 Jul;3(3):179-185. 10.5415/apallergy.2013.3.3.179.

Sensitization patterns of cow's milk and major components in young children with atopic dermatitis

• Lee JM
• Yoon JS
• Jeon SA
• Lee SY

• KMID: 2397311
• DOI: http://doi.org/10.5415/apallergy.2013.3.3.179

Abstract

BACKGROUND
Cow's milk (CM) is one of the most common food allergens in children with atopic dermatitis (AD), and the component-specific immunoglobulin E (component-IgE) measurement has recently become available.
OBJECTIVE
This study aimed to investigate the sensitization patterns to CM and 3 major components and their clinical values in young Korean children with AD.
METHODS
Cow's milk-specific IgE (CM-IgE), α-lactalbumin-specific IgE (ALA-IgE), β-lactoglobulin-specific IgE (BLG-IgE), and casein-specific IgE (Cas-IgE) levels from the sera of patients with AD were measured using the UniCAP™ system (Thermo Fisher Scientific, Sweden) and collected from January 2004 to December 2010. Patients ≥ 4 years of age were excluded from the analysis.
RESULTS
A total of 950 patients diagnosed with AD were ultimately enrolled in the study. Among them, 471 (49.6%) patients were sensitized to CM (CM-IgE[+], > 0.35 kU/L). Sensitization to casein (n = 349, 74.1%) was most common, followed by ALA (n = 283, 60.1%), and BLG (n = 245, 52.5%). Meanwhile, 95 patients had at least 2 follow-up tests. Eighty (84.2%) of these patients tested positive to CM, and the casein sensitization rate was the highest (n = 65, 81.3%). In addition, 479 (50.4%) patients were not sensitized to CM (CM-IgE[-], ≤ 0.35 kU/L) but 35 (7.3%) patients were sensitized to at least one component. Among them, a telephone survey was accessible in 21 cases. A total of 8 (38.1%) patients still suffered from adverse reactions after consuming milk and/or dairy foods.
CONCLUSION
Casein was the most commonly and persistently sensitized component in CM-IgE(+) children with AD. Measuring CM component IgE antibodies, especially Cas-IgE, is helpful for evaluating problematic allergens in young children with AD.

Keyword

Atopic dermatitis; Children; Cow's milk; Casein

MeSH Terms

Allergens
Antibodies
Caseins
Child*
Dermatitis, Atopic*
Follow-Up Studies
Humans
Immunoglobulin E
Immunoglobulins
Milk*
Telephone
Allergens
Antibodies
Caseins
Immunoglobulin E
Immunoglobulins

Figure

• 

  Fig. 1 Correlation between the concentration of CM-IgE and ALA-IgE in infants and young children with atopic dermatitis. There was a statistically significant correlation between the levels of CM-IgE and ALA-IgE (r = 0.494; p < 0.001). CM-IgE, cow's milk-specific IgE (kU/L); ALA-IgE, α-lactalbumin-specific IgE (kU/L).

• 

  Fig. 2 Correlation between the concentration of CM-IgE and BLG-IgE in children with atopic dermatitis. There was a statistically significant correlation between the level of CM-IgE and ALA-IgE. (r = 0.613; p < 0.001). CM-IgE, cow's milk-specific IgE (kU/L); BLG-IgE, β-lactoglobulin-specific IgE (kU/L).

• 

  Fig. 3 Correlation between the concentration of CM-IgE and Cas-IgE in children with atopic dermatitis. There was a statistically significant correlation between the level of CM-IgE and Cas-IgE (r = 0.806; p < 0.001). CM-IgE, cow's milk-specific IgE (kU/L); Cas-IgE, casein-specific IgE (kU/L).

Reference

1. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007; 120:638–646. PMID: 17628647.

2. Bock SA, Sampson HA. Evaluation of food allergy. In : Leung DY, Sampson HA, Geha R, Szefler SJ, editors. Pediatric allergy: principles and practice. 2nd ed. Philadelphia (PA): Saunders;2010. p. 477–486.

3. Oh JW, Pyun BY, Choung JT, Ahn KM, Kim CH, Song SW, Son JA, Lee SY, Lee SI. Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000. J Korean Med Sci. 2004; 19:716–723. PMID: 15483350.

4. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics. 1987; 79:683–688. PMID: 3575022.

5. Høst A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy. 1990; 45:587–596. PMID: 2288394.

6. Järvinen KM, Beyer K, Vila L, Chatchatee P, Busse PJ, Sampson HA. B-cell epitopes as a screening instrument for persistent cow's milk allergy. J Allergy Clin Immunol. 2002; 110:293–297. PMID: 12170271.

7. Wal JM. Cow's milk allergens. Allergy. 1998; 53:1013–1022. PMID: 9860234.

8. Sicherer SH, Sampson HA. Cow's milk protein-specific IgE concentrations in two age groups of milk-allergic children and in children achieving clinical tolerance. Clin Exp Allergy. 1999; 29:507–512. PMID: 10202365.

9. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cows' milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy. 1993; 23:124–131. PMID: 8448679.

10. Docena GH, Fernandez R, Chirdo FG, Fossati CA. Identification of casein as the major allergenic and antigenic protein of cow's milk. Allergy. 1996; 51:412–416. PMID: 8837665.

11. Tabar AI, Alvarez MJ, Echechipía S, Acero S, Garcia BE, Olaguíbel JM. Anaphylaxis from cow's milk casein. Allergy. 1996; 51:343–345. PMID: 8836341.

12. Shin MY, Han YS, Park HY, Ahn YH, Chung EH, Ahn KM, Lee SI. Cow's milk protein-specific IgE concentrations in two age groups of children with cow's milk allergy. Pediatr Allergy Respir Dis. 2004; 14:207–214.

13. Chatchatee P, Järvinen KM, Bardina L, Beyer K, Sampson HA. Identification of IgE- and IgG-binding epitopes on alpha(s1)-casein: differences in patients with persistent and transient cow's milk allergy. J Allergy Clin Immunol. 2001; 107:379–383. PMID: 11174208.

14. Wang J, Lin J, Bardina L, Goldis M, Nowak-Wegrzyn A, Shreffler WG, Sampson HA. Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy. J Allergy Clin Immunol. 2010; 125:695–702. PMID: 20226304.

15. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001; 107:891–896. PMID: 11344358.

16. García-Ara C, Boyano-Martínez T, Díaz-Pena JM, Martín-Muñoz F, Reche-Frutos M, Martín-Esteban M. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant. J Allergy Clin Immunol. 2001; 107:185–190. PMID: 11150010.

17. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980; 59:44–47.

18. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr. 1988; 113:447–451. PMID: 3411388.

19. Sampson HA, Metcalfe DD. Food allergies. JAMA. 1992; 268:2840–2844. PMID: 1433699.

20. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998; 101:E8. PMID: 9481027.

21. Byrne AM, Malka-Rais J, Burks AW, Fleischer DM. How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved? Clin Exp Allergy. 2010; 40:1303–1311. PMID: 20645999.

22. Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. The natural progression of peanut allergy: resolution and the possibility of recurrence. J Allergy Clin Immunol. 2003; 112:183–189. PMID: 12847497.

23. Sampson HA. Food allergy--accurately identifying clinical reactivity. Allergy. 2005; 60(Suppl 79):19–24. PMID: 15842229.

24. Boyano-Martínez T, García-Ara C, Pedrosa M, Díaz-Pena JM, Quirce S. Accidental allergic reactions in children allergic to cow's milk proteins. J Allergy Clin Immunol. 2009; 123:883–888. PMID: 19232704.

25. Gern JE, Yang E, Evrard HM, Sampson HA. Allergic reactions to milkcontaminated "nondairy" products. N Engl J Med. 1991; 324:976–979. PMID: 2002820.

26. Vereda A, van Hage M, Ahlstedt S, Ibañez MD, Cuesta-Herranz J, van Odijk J, Wickman M, Sampson HA. Peanut allergy: clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol. 2011; 127:603–607. PMID: 21093026.

27. Kramer MS. Breastfeeding and allergy: the evidence. Ann Nutr Metab. 2011; 59:20–26. PMID: 22189253.

28. Boyce JA, Assa'a A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM. NIAID-sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-Sponsored Expert Panel Report. Nutrition. 2011; 27:253–267. PMID: 21215925.