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Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE.

Abstract

BACKGROUND

The objective of the present study was to evaluate the relevance of skin tests and the concentration of cow's milk-specific IgE antibodies in correlation with oral cow's milk challenge in infants with suspected cow's milk allergy.

METHODS

The study material comprised 143 infants under the age of 2 years who had undergone a diagnostic elimination challenge because of suspected cow's milk allergy in 1996. Cow's milk-specific IgE was measured, and skin prick and patch tests were performed.

RESULTS

Of the 143 oral cow's milk challenges performed, 72 (50%) were positive. Of the positive reactions, 22 involved immediate-type reactions. In 50 patients, delayed-onset reactions of eczematous or gastrointestinal type appeared. Of the infants with challenge-proven cow's milk allergy, 26% showed elevated IgE concentrations to cow's milk, 14% had a positive skin prick test, and 44% had a positive patch test for cow's milk. Interestingly, in most patch test-positive patients, the prick test for cow's milk was negative.

CONCLUSIONS

Our study demonstrated that many patients with a negative prick test result had a positive patch test to cow's milk. The patch test was a more sensitive method than the prick test or RAST to detect cow's milk allergy in this study population. Our results indicate that patch testing will significantly increase the probability of early detection of cow's milk allergy. Confirmation of the diagnosis is essential in patients with negative test results but a clinical suspicion of food allergy, and in patch test-positive patients. For this purpose, the most reliable method is the elimination-challenge procedure.

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  • Authors+Show Affiliations

    ,

    Medical School, University of Tampere, Finland.

    , , ,

    Source

    Allergy 54:4 1999 Apr pg 346-51

    MeSH

    Allergens
    Animals
    Child, Preschool
    Double-Blind Method
    Female
    Humans
    Immunoglobulin E
    Infant
    Infant Food
    Infant, Newborn
    Male
    Milk
    Milk Hypersensitivity
    Patch Tests
    Radioallergosorbent Test
    Skin Tests

    Pub Type(s)

    Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10371093

    Citation

    Majamaa, H, et al. "Cow's Milk Allergy: Diagnostic Accuracy of Skin Prick and Patch Tests and Specific IgE." Allergy, vol. 54, no. 4, 1999, pp. 346-51.
    Majamaa H, Moisio P, Holm K, et al. Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE. Allergy. 1999;54(4):346-51.
    Majamaa, H., Moisio, P., Holm, K., Kautiainen, H., & Turjanmaa, K. (1999). Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE. Allergy, 54(4), pp. 346-51.
    Majamaa H, et al. Cow's Milk Allergy: Diagnostic Accuracy of Skin Prick and Patch Tests and Specific IgE. Allergy. 1999;54(4):346-51. PubMed PMID: 10371093.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE. AU - Majamaa,H, AU - Moisio,P, AU - Holm,K, AU - Kautiainen,H, AU - Turjanmaa,K, PY - 1999/6/17/pubmed PY - 1999/6/17/medline PY - 1999/6/17/entrez SP - 346 EP - 51 JF - Allergy JO - Allergy VL - 54 IS - 4 N2 - BACKGROUND: The objective of the present study was to evaluate the relevance of skin tests and the concentration of cow's milk-specific IgE antibodies in correlation with oral cow's milk challenge in infants with suspected cow's milk allergy. METHODS: The study material comprised 143 infants under the age of 2 years who had undergone a diagnostic elimination challenge because of suspected cow's milk allergy in 1996. Cow's milk-specific IgE was measured, and skin prick and patch tests were performed. RESULTS: Of the 143 oral cow's milk challenges performed, 72 (50%) were positive. Of the positive reactions, 22 involved immediate-type reactions. In 50 patients, delayed-onset reactions of eczematous or gastrointestinal type appeared. Of the infants with challenge-proven cow's milk allergy, 26% showed elevated IgE concentrations to cow's milk, 14% had a positive skin prick test, and 44% had a positive patch test for cow's milk. Interestingly, in most patch test-positive patients, the prick test for cow's milk was negative. CONCLUSIONS: Our study demonstrated that many patients with a negative prick test result had a positive patch test to cow's milk. The patch test was a more sensitive method than the prick test or RAST to detect cow's milk allergy in this study population. Our results indicate that patch testing will significantly increase the probability of early detection of cow's milk allergy. Confirmation of the diagnosis is essential in patients with negative test results but a clinical suspicion of food allergy, and in patch test-positive patients. For this purpose, the most reliable method is the elimination-challenge procedure. SN - 0105-4538 UR - https://www.unboundmedicine.com/medline/citation/10371093/Cow's_milk_allergy:_diagnostic_accuracy_of_skin_prick_and_patch_tests_and_specific_IgE_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0105-4538&date=1999&volume=54&issue=4&spage=346 DB - PRIME DP - Unbound Medicine ER -