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Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort.
Allergy. 2015 Aug; 70(8):963-72.A

Abstract

BACKGROUND

Cow's milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria.

METHODS

Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge.

RESULTS

Across Europe, 12 049 children were enrolled, and 9336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in the Netherlands and UK) to <0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cow's milk-specific IgE in serum, especially those from UK, the Netherlands, Poland and Italy. Of children with CMA who were re-evaluated one year after diagnosis, 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA.

CONCLUSIONS

This unique pan-European birth cohort study using the gold standard diagnostic procedure for food allergies confirmed challenge-proven CMA in <1% of children up to age 2. Affected infants without detectable specific antibodies to cow's milk were very likely to tolerate cow's milk one year after diagnosis, whereas only half of those with specific antibodies in serum 'outgrew' their disease so soon.

Authors+Show Affiliations

Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK. NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany.Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany.Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany. German Agency for Quality in Medicine, Berlin, Germany.Faculty of Medicine, Vilnius University, Vilnius, Lithuania.Faculty of Medicine, Vilnius University, Vilnius, Lithuania.Sofia Children's University Hospital, Madrid, Spain.University Hospital La Paz, Madrid, Spain.Department of Allergy, Second Paediatric Clinic, University of Athens, Athens, Greece.Neonatal Division, Second Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece.Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy.Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy.Department of Immunology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.Children's Hospital, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.Department of Pediatrics, Preventive Cardiology and Immunology, Medical University of Łódź, Łódź, Poland.Department of Pediatrics, Preventive Cardiology and Immunology, Medical University of Łódź, Łódź, Poland. Department of Pediatrics, Immunology and Nephrology, Department of Pediatrics, Clinical Immunology and Cardiology, Polish Mother's Health Centre Research Institute Łódź, Medical University of Łódź, Łódź, Poland.Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany.Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25864712

Citation

Schoemaker, A A., et al. "Incidence and Natural History of Challenge-proven Cow's Milk Allergy in European children--EuroPrevall Birth Cohort." Allergy, vol. 70, no. 8, 2015, pp. 963-72.
Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy. 2015;70(8):963-72.
Schoemaker, A. A., Sprikkelman, A. B., Grimshaw, K. E., Roberts, G., Grabenhenrich, L., Rosenfeld, L., Siegert, S., Dubakiene, R., Rudzeviciene, O., Reche, M., Fiandor, A., Papadopoulos, N. G., Malamitsi-Puchner, A., Fiocchi, A., Dahdah, L., Sigurdardottir, S. T., Clausen, M., Stańczyk-Przyłuska, A., Zeman, K., ... Beyer, K. (2015). Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy, 70(8), 963-72. https://doi.org/10.1111/all.12630
Schoemaker AA, et al. Incidence and Natural History of Challenge-proven Cow's Milk Allergy in European children--EuroPrevall Birth Cohort. Allergy. 2015;70(8):963-72. PubMed PMID: 25864712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. AU - Schoemaker,A A, AU - Sprikkelman,A B, AU - Grimshaw,K E, AU - Roberts,G, AU - Grabenhenrich,L, AU - Rosenfeld,L, AU - Siegert,S, AU - Dubakiene,R, AU - Rudzeviciene,O, AU - Reche,M, AU - Fiandor,A, AU - Papadopoulos,N G, AU - Malamitsi-Puchner,A, AU - Fiocchi,A, AU - Dahdah,L, AU - Sigurdardottir,S Th, AU - Clausen,M, AU - Stańczyk-Przyłuska,A, AU - Zeman,K, AU - Mills,E N C, AU - McBride,D, AU - Keil,T, AU - Beyer,K, Y1 - 2015/05/18/ PY - 2015/04/06/accepted PY - 2015/4/14/entrez PY - 2015/4/14/pubmed PY - 2016/5/3/medline KW - EuroPrevall KW - birth cohort study KW - cow's milk allergy KW - food allergy KW - incidence SP - 963 EP - 72 JF - Allergy JO - Allergy VL - 70 IS - 8 N2 - BACKGROUND: Cow's milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria. METHODS: Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge. RESULTS: Across Europe, 12 049 children were enrolled, and 9336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in the Netherlands and UK) to <0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cow's milk-specific IgE in serum, especially those from UK, the Netherlands, Poland and Italy. Of children with CMA who were re-evaluated one year after diagnosis, 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA. CONCLUSIONS: This unique pan-European birth cohort study using the gold standard diagnostic procedure for food allergies confirmed challenge-proven CMA in <1% of children up to age 2. Affected infants without detectable specific antibodies to cow's milk were very likely to tolerate cow's milk one year after diagnosis, whereas only half of those with specific antibodies in serum 'outgrew' their disease so soon. SN - 1398-9995 UR - https://www.unboundmedicine.com/medline/citation/25864712/Incidence_and_natural_history_of_challenge_proven_cow's_milk_allergy_in_European_children__EuroPrevall_birth_cohort_ L2 - https://doi.org/10.1111/all.12630 DB - PRIME DP - Unbound Medicine ER -