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Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review.
Ital J Pediatr 2017; 43(1):93IJ

Abstract

BACKGROUND

The diagnosis of IgE-mediated cow's milk allergy is often based on anamnesis, and on specific IgE (sIgE) levels and/or Skin Prick Tests (SPT), which have both a good sensitivity but a low specificity, often causing positive results in non-allergic subjects. Thus, oral food challenge is still the gold standard test for diagnosis, though being expensive, time-consuming and possibly at risk for severe allergic reactions.

AIM

The aim of the present study was to perform a systematic review of the studies that have so far analyzed the positive predictive values for sIgE and SPT in the diagnosis of allergy to fresh and baked cow's milk according to age, and to identify possible cut-offs that may be useful in clinical practice.

METHODS

A comprehensive search on Medline via PubMed and Scopus was performed August 2017. Studies were included if they investigated possible sIgE and/or SPT cut-off values for cow's milk allergy diagnosis in pediatric patients. The quality of the studies was evaluated according to QUADAS-2 criteria.

RESULTS

The search produced 471 results on Scopus, and 2233 on PubMed. Thirty-one papers were included in the review and grouped according to patients' age, allergen type and cooking degree of the milk used for the oral food challenge. In children < 2 years, CMA diagnosis seems to be highly likely when sIgE to CM extract are ≥ 5 KUA/L or when SPT with commercial extract are above 6 mm or Prick by Prick (PbP) with fresh cow's milk are above 8 mm. Any cut-offs are proposed for single cow's milk proteins and for baked milk allergy in children younger than 2 years. In Children ≥ 2 years of age it is hard to define practical cut-offs for allergy to fresh and baked cow's milk. Cut-offs identified are heterogeneous.

CONCLUSIONS

None of the cut-offs proposed in the literature can be used to definitely confirm cow's milk allergy diagnosis, either to fresh pasteurized or to baked milk. However, in children < 2 years, cut-offs for specific IgE or SPT seem to be more homogeneous and may be proposed.

Authors+Show Affiliations

Operative Complex Unit of Pediatrics, Belcolle Hospital, Viterbo, Italy. bcuomo@libero.it.Operative Unit of PediatricAllergy, San Giuseppe da Copertino Hospital, Copertino, LE, Italy.Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.Department of Pediatrics, University of Messina, Messina, Italy.Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, France. Sorbonnes Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, F-75013, Paris, France.Department of Pediatric Emergency, S.Orsola-Malpighi Hospital, Bologna, Italy.Institute of Biomedicine and Molecular Immunology, National Research Council, 90100, Palermo, Italy.L'altrastatisticasrl, Consultancy & Training, Biostatistics office, Rome, Italy.Primary Care Pediatrics, ASL Salerno, Vietri sul Mare, SA, Italy.Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

29025431

Citation

Cuomo, Barbara, et al. "Specific IgE and Skin Prick Tests to Diagnose Allergy to Fresh and Baked Cow's Milk According to Age: a Systematic Review." Italian Journal of Pediatrics, vol. 43, no. 1, 2017, p. 93.
Cuomo B, Indirli GC, Bianchi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review. Ital J Pediatr. 2017;43(1):93.
Cuomo, B., Indirli, G. C., Bianchi, A., Arasi, S., Caimmi, D., Dondi, A., ... Calvani, M. (2017). Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review. Italian Journal of Pediatrics, 43(1), p. 93. doi:10.1186/s13052-017-0410-8.
Cuomo B, et al. Specific IgE and Skin Prick Tests to Diagnose Allergy to Fresh and Baked Cow's Milk According to Age: a Systematic Review. Ital J Pediatr. 2017 Oct 12;43(1):93. PubMed PMID: 29025431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review. AU - Cuomo,Barbara, AU - Indirli,Giovanni Cosimo, AU - Bianchi,Annamaria, AU - Arasi,Stefania, AU - Caimmi,Davide, AU - Dondi,Arianna, AU - La Grutta,Stefania, AU - Panetta,Valentina, AU - Verga,Maria Carmen, AU - Calvani,Mauro, Y1 - 2017/10/12/ PY - 2017/02/06/received PY - 2017/09/26/accepted PY - 2017/10/14/entrez PY - 2017/10/14/pubmed PY - 2018/7/17/medline KW - Casein KW - Children KW - Cow’s milk allergy KW - Cut-offs KW - Oral food challenge KW - Positive predictive value KW - Predictive value KW - Skin prick test KW - Specificity KW - α-lactalbumin KW - β-lactoglobulin SP - 93 EP - 93 JF - Italian journal of pediatrics JO - Ital J Pediatr VL - 43 IS - 1 N2 - BACKGROUND: The diagnosis of IgE-mediated cow's milk allergy is often based on anamnesis, and on specific IgE (sIgE) levels and/or Skin Prick Tests (SPT), which have both a good sensitivity but a low specificity, often causing positive results in non-allergic subjects. Thus, oral food challenge is still the gold standard test for diagnosis, though being expensive, time-consuming and possibly at risk for severe allergic reactions. AIM: The aim of the present study was to perform a systematic review of the studies that have so far analyzed the positive predictive values for sIgE and SPT in the diagnosis of allergy to fresh and baked cow's milk according to age, and to identify possible cut-offs that may be useful in clinical practice. METHODS: A comprehensive search on Medline via PubMed and Scopus was performed August 2017. Studies were included if they investigated possible sIgE and/or SPT cut-off values for cow's milk allergy diagnosis in pediatric patients. The quality of the studies was evaluated according to QUADAS-2 criteria. RESULTS: The search produced 471 results on Scopus, and 2233 on PubMed. Thirty-one papers were included in the review and grouped according to patients' age, allergen type and cooking degree of the milk used for the oral food challenge. In children < 2 years, CMA diagnosis seems to be highly likely when sIgE to CM extract are ≥ 5 KUA/L or when SPT with commercial extract are above 6 mm or Prick by Prick (PbP) with fresh cow's milk are above 8 mm. Any cut-offs are proposed for single cow's milk proteins and for baked milk allergy in children younger than 2 years. In Children ≥ 2 years of age it is hard to define practical cut-offs for allergy to fresh and baked cow's milk. Cut-offs identified are heterogeneous. CONCLUSIONS: None of the cut-offs proposed in the literature can be used to definitely confirm cow's milk allergy diagnosis, either to fresh pasteurized or to baked milk. However, in children < 2 years, cut-offs for specific IgE or SPT seem to be more homogeneous and may be proposed. SN - 1824-7288 UR - https://www.unboundmedicine.com/medline/citation/29025431/Specific_IgE_and_skin_prick_tests_to_diagnose_allergy_to_fresh_and_baked_cow's_milk_according_to_age:_a_systematic_review_ L2 - https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0410-8 DB - PRIME DP - Unbound Medicine ER -