Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025
The utility of casein skin prick test and IgE values in predicting anaphylaxis and reactivity to baked milk.
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Cogurlu Mujde Tuba, Uluc Nezihe Nefise, Ozanli Ismail, Ozkan Yeşim Ece, Iskender Nagihan, Balci Sibel, Simsek Isıl Eser, Aydogan Metin
Аннотация
BACKGROUND: Most children with milk allergy can tolerate baked milk (BM); however, a small percent still react to it. Identifying indicators that might forecast potential reactions to baked goods is essential.
OBJECTIVE: To determine the predictive factors and some decision points for estimation of BM reactivity and severe reactions.
METHODS: A cross-sectional study was performed. Participants who were reactive to unheated milk underwent an oral food challenge with BM. The reactive group was classified into anaphylactic and non-anaphylactic reaction categories. The IgE and skin prick test (SPT) levels of milk and its components were compared among these groups.
RESULTS: The study was conducted with 110 patients. The median age of participants was 16 (IQR: 12-31) months. BM reactivity was observed in 41% (n = 46/110) of the patients. The optimal cutoff point for BM reactivity was 4.68 kIU/L for casein specific IgE (sIgE) (84% specificity, 75% sensitivity, area under the curve [AUC]: 0.827) and 7 mm for casein SPT (87.2% specificity, 51.1% sensitivity, AUC: 0.721) (P < .001, P < .001). The positive decision point for anaphylaxis for casein sIgE was 34 kIU/L (95% specificity, 47.6% sensitivity, AUC: 0.707). In the group younger than 24 months old, the cutoff values for casein sIgE were found to be 5.4 kIU/L (95% specificity, 66.6% sensitivity, AUC: 0.844) and casein SPT at 7 mm (91% specificity, 37% sensitivity, AUC: 0.708) (P < .001, P = .002).
CONCLUSION: Our investigation revealed that the most accurate indicator for BM reactivity was casein sIgE and SPT. Although we established a threshold for severe reaction with BM in our study population, we consider that our findings require validation before therapeutic implementation.
OBJECTIVE: To determine the predictive factors and some decision points for estimation of BM reactivity and severe reactions.
METHODS: A cross-sectional study was performed. Participants who were reactive to unheated milk underwent an oral food challenge with BM. The reactive group was classified into anaphylactic and non-anaphylactic reaction categories. The IgE and skin prick test (SPT) levels of milk and its components were compared among these groups.
RESULTS: The study was conducted with 110 patients. The median age of participants was 16 (IQR: 12-31) months. BM reactivity was observed in 41% (n = 46/110) of the patients. The optimal cutoff point for BM reactivity was 4.68 kIU/L for casein specific IgE (sIgE) (84% specificity, 75% sensitivity, area under the curve [AUC]: 0.827) and 7 mm for casein SPT (87.2% specificity, 51.1% sensitivity, AUC: 0.721) (P < .001, P < .001). The positive decision point for anaphylaxis for casein sIgE was 34 kIU/L (95% specificity, 47.6% sensitivity, AUC: 0.707). In the group younger than 24 months old, the cutoff values for casein sIgE were found to be 5.4 kIU/L (95% specificity, 66.6% sensitivity, AUC: 0.844) and casein SPT at 7 mm (91% specificity, 37% sensitivity, AUC: 0.708) (P < .001, P = .002).
CONCLUSION: Our investigation revealed that the most accurate indicator for BM reactivity was casein sIgE and SPT. Although we established a threshold for severe reaction with BM in our study population, we consider that our findings require validation before therapeutic implementation.