Evaluation of ige mediated cow's milk and egg allergy in children

Objective:. The aim of our study was to define the natural history of IgE mediated cow's milk and/or egg allergy and identify the factors predicting the development of tolerance. Materials and methods: This is a retrospective study of 87 patients (65.5% M) who have been followed up with IgE-mediated cow's milk and /or egg allergy in the outpatient clinic of Pediatric Allergy Department, between January 2013 and December 2018. Demographic characteristics, clinical signs and findings, laboratory tests and tolerance development cases in the following 1st, 2nd and 3rd years were recorded from the files. Results: The age of onset of symptoms was 5.1 ± 4.3 months, and the transition to complementary feeding was 4.9 ± 2.0 months. Of the patients, 34.5% had additional allergic disease and 32.1% had a family history of atopy. The most common allergic disease was atopic dermatitis in personal (13,8%) and family (maternal) history of atopy (6,9%). The most common complaint was urticaria (48.3%). The total IgE levels of the patients were 251.0 ± 875.1 kU / L, and the eosinophil percentages were 4.8 ± 3.9. Cow's milk sIgE, egg white sIgE levels were 12.3 ± 25.9 kUA /L and 9.0 ± 20.5 kUA / L, respectively. Skin prick tests (SPT) were found positive in 22 (34.2%) patients for cow's milk; 17 (51.5%) patients for egg white. Of the 145 open oral food challenge tests (OFT), 32 (22.0%) were positive. Resolution developed in 48 (55.1%) patients at the end of the third year (cow milk: 31 (42.2%), egg: 17 (41.1%). The family history of atopy increased the risk of persistant food allergy (p = 0.049). Ther was a siginificant association between SPT (p = 0.012), cow's milk sIgE (p = 0.010) ,casein sIgE levels (p = 0.025), eosinophil level (p = 0.016) and cow's milk tolerance, and between eosinophil percentage (p = 0.006) and egg tolerance. Conclusion: Development of tolerance in only half of patients with cow's milk and egg allergy shows that the prognosis for the resolution of IgE-mediated food allergy is worse than previously reported. Family history of atopy and high cow's milk sIgE and casein sIgE levels were found to be negative prognostic factors for development of tolerance in cow's milk allergy.