Cow's Milk Allergy: the Relevance of IgE

86 http://e-aair.org Cow’s milk allergy (CMA) accounts for most diagnosed food allergies, mainly in the first year of life. CMA can cause severe anaphylaxis. CMA management is based on strict avoidance and the prescription of rescue medication. Cow’s milk (CM) contains more than 40 proteins, including casein (Bos d 8), -lactalbumin (Bos d 4), and -lactoglobulin (Bos d 5), identified as major milk allergens. Serum specific IgE (sIgE) to casein characterized patients with persistent CMA, CM tolerance, and reactivity to baked milk. Oral immunotherapy (OIT) for CMA has been used with interesting outcomes as it may induce immunologic tolerance. However, a safety perspective represents a relevant concern, because reactions to OIT are frequent It has been demonstrated that sIgE to raw CM >50 kUA/L predicted not-tolerated OIT. Molecular-based allergy diagnostics have now become recently available in clinical practice. This method allows for defining and characterizing the sensitization profile that identifies potentially dangerous proteins and suggests a more precise prognosis. In this regard, Cingolani and colleagues reported that component resolved diagnosis had a good ability to define 2 phenotypes of CMA children: “high-anaphylaxis risk” and “milder-risk”. In particular, these phenotypes can be differentiated through measuring the level of sIgE to Bos d 8. We now report our experience concerning a retrospective cohort. This observational and retrospective experience evaluated the usefulness of ImmunoCAP and ISAC (please describe company, city, country) to detect anaphylaxis after CM ingestion. We evaluated children with CMA diagnosis who consecutively visited the Istituto Gaslini (a third tier children’s hospital) in the last year. CMA diagnosis was performed on suggestive history consistent with CM sensitization (i.e. symptom occurrence after milk ingestion), documented milk sensitization, and a positive food challenge test. Anaphylaxis was defined according to validated criCow’s Milk Allergy: the Relevance of IgE Maria Angela Tosca, Angela Pistorio, Giovanni Arturo Rossi, Giorgio Ciprandi*