Abstract

Introduction: Food allergies are responses triggered by various immunological mechanisms to foods or additives, manifesting through IgE, non-IgE or mixed-type reactions. In IgE-mediated food allergies, skin findings (such as urticaria, angioedema, skin redness) are common, along with cough, rhinorrhea, shortness of breath, and symptoms extending to anaphylaxis. This study aims to evaluate the clinical presentations and factors playing a role in tolerance development in patients diagnosed with IgE-mediated cow’s milk allergy (CMA).

Materials and Methods: Our study encompasses a retrospective evaluation of the files of patients who were diagnosed with IgE-mediated CMA and developed tolerance, and who presented to the Prof. Dr. Cemil Taşçıoğlu City Hospital Pediatric Allergy and Immunology clinic between the years 2018-2022.

Results: The average age of the 75 patients was 14.4 months, with 65.3% being males. Tolerance development was observed in 56% of patients before reaching 24 months of age. In the group with tolerance development age ≥ 24 months, statistically significantly higher rates of positive food challenge tests and inhalant allergen sensitivity were noted. In patients who developed tolerance after 24 months, family history of atopy, additional allergic diseases, and inhalant allergen sensitivity were more frequent. In this group, the mean skin prick induration diameter, serum-specific IgE levels for milk and casein, and total serum IgE levels were significantly higher. ROC analysis evaluated a cut-off point of 1.30 for casein-specific IgE with a sensitivity of 93% and a specificity of 67%.

Conclusion: CMA is commonly observed in children, yet research on tolerance development is quite limited. However, our study, contrary to existing literature, suggests that tolerance can develop in a shorter period. Furthermore, we found that tolerance developed later in children with a family history of atopy, accompanying additional allergic diseases, and a history of anaphylaxis, as well as those with a larger skin prick induration diameter at the time of diagnosis, and higher levels of total serum IgE, milk-specific IgE, and casein-specific IgE.