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The Natural History of IgE-Mediated Cow's Milk AllergyJustin M. Skripak, MD, Elizabeth C. Matsui, MD MHS, Kim Mudd, RN, Robert A.Wood, MD Bad news, good news, and more good news Let's get right to the bad news. The prognosis for milk-allergic children developing tolerance to cow's milk is worse than previously estimated. The party-line used to be that 75% of children with IgE-mediated cow's milk allergy (CMA) were tolerant by the age of three years. The authors of the present study found that milk tolerance ranged from <1% to 26% at 4 years. The good news is that, whereas it used to be said that cow's milk allergy was unlikely to be lost if it had persisted into the school-age years, this study found that patients did continue to achieve tolerance well into adolescence, indicating that there is no age at which outgrowing CMA is impossible. The last bit of good news is that cow's milk-IgE (cm-IgE) is highly predictive of outcome. The authors found that the higher the peak cm-IgE level, the less likely CMA would resolve. Co-existing asthma and allergic rhinitis were also found to be a significant predictor of a reduced chance of developing tolerance. These findings provide important information for counseling patients and their families regarding the long-term prognosis of CMA. |
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