The evaluati̇on of cow's mi̇lk allergy i̇n atopi̇k chi̇ldren

BACKGROUND AND OBJECTIVE: In atopic diseases, food allergy and atopic dermatitis are the first step of atopic march. Cow?s milk allergy is the most common food allergy particularly in small children. The aim of the present study was to evaluate the prevelance of cow?s milk allergy, the rate of cross-reactivity among other mammalian milks and the sensitivity of diagnostic tests. MATERIAL AND METHODS: Sixty-three children between the ages of 0-2 with the diagnosis of atopic dermatitis and wheezy infant attended to Adnan Menderes University Medical Faculty Department of Pediatric Immunology and Allergy between the dates of 2010-2012, were recruited to the study. The symptoms, previous history, family history, eating habits and concomitant atopic diseases were questionered. Blood samples were collected for Total IgE and specific IgE analysis. Skin prick tests with cow?s milk, sheep?s milk, goat?s milk and camel?s milk, as well as, atopy patch test and open food provocation test with cow?s milk were performed. RESULTS: Tweny-eight (44%) of 63 atopic cases with atopic dermatitis and wheezing were diagnosed as CMA. Early reaction was detected in 69% and late reaction in 31% of the cases during open food challange. Cow?s milk allergy was detected in chidren with atopic dermatitis in 49%, wheezy infant in 30%, atopic dermatitis and wheezy infant in 30%, gastrointestinal symptoms in 100%. Cross reaction between CM and goat?s milk in 82.6%, sheep?s milk in 87%, camel?s milk in 13% in skin prick test and goat?s milk in 86.7%, sheep?s milk in 90%, camel?s milk in 33.3% in atopy patch test. In early reactions, sensitivity was concordant best with specific IgE (50%), specifity and positive predictive value (PPD) with SPT and APT (15. min.) 100%, negative predictive value (NPV) with specific IgE (74.3%). In late reactions, sensitivity was concordant best with specific IgE and APT (48. hour) 50%, specifity and with SPT and APT (15. min.) 100%, negative predictive value (NPV) with APT (48.hour) 86.5%. CONCLUSION: In this study, it was shown that cow's milk allergy in atopic patients are common. In patients with CMA, SPT and APT revealed a high rate of cross-reaction with goat?s and sheep's milk, while a low rate of cross-reaction was seeen with camel?s milk. Evaluation of diagnostic tests based on overt provocations showed that APT (15th min) assessment was effective to determine early reactions, and APT (48th hour) assessment was effective to determine late reactions.