Blood or skin: what is best in predicting cow’s milk allergy diagnosis?

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Authors Information

1Immunoallergology Service, Centro Hospitalar Universitário de Lisboa Central EPE, Lisbon, Portuga
2Immunoallergology Unit, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
3NOVA Medical School, Comprehensive Health Research Center (CHRC), Lisbon, Portugal
4Clinical Pathology Service, Centro Hospitalar Universitário de Lisboa Central EPE, Lisbon, Portugal


Published online: 5 September 2019
Accepted: 19 November 2019
Received: 6 September 2019


Cut-off values for both skin prick tests (SPT) and specific IgE (sIgE) levels for predicting cow´s milk allergy (CMA) diagnosis are not universally defined. This study is a retrospective analysis of consecutive children (0-18 years-old) with suspected CMA tested with SPT and sIgE for cow’s milk (CM) and its fractions between 2016-2017. CMA diagnosis was defined by a positive oral food challenge or a highly suggestive clinical history of CMA and SPT and/or sIgE positive to CM and/or its fractions. One hundred and five patients were included, 58% males with a median age of 2.5 (P25-P75:1-6) years and the diagnosis was confirmed in 83 patients (79%). The variables associated with CMA diagnosis were SPT with CM (p minor 0,05) and casein (p minor 0,05) and all sIgE to CM and its fractions (alfa-Lactalbumin, beta-Lactoglobulin and casein; p<0,05 for all). Optimal cut39 off points (Youden’s index) for CMA diagnosis were, for the mean wheal diameter, to CM milk of 4.5mm and to casein of 3mm. For sIgE levels the optimal cut-off points were: for CM of 4.36 kUA/L, alfa-lactalbumin of 1.6 kUA/L, beta-lactoglobulin of 1.7 kUA/L and for casein of 2.6 kUA/L. The role of SPT and sIgE levels to cow´s mlik and its fractions is unequivocal in CMA follow-up. Moreover, sIgE levels seem to be more discriminatory than SPT.

IgE; milk allergy; sensitivity; specificity; skin tests.

Table of Content: Vol. 52 (No. 4) 2020 July

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