Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals

The Milan Cow's Milk Allergy Cohort study

Alessandro Fiocchi, Luigi Terracciano, Gabriel R. Bouygue, Fabrizio Veglia, Teresita Sarratud, Alberto Martelli, Patrizia Restani

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally. Objective: To prospectively determine prognostic predictors of tolerance in a random cohort of referrals using CMA workup outcomes as covariates and tolerance as the status variable in a duration model of CMA. Methods: The 2001-2006 Milan Cow's Milk Allergy Cohort (MiCMAC) enrolled children referrals using double-blind, placebo-controlled food challenges (DBPCFCs) as study end points (confirmation of CMA; onset of tolerance). The Cox regression model was used to analyze all clinical factors that contributed to tolerance. Covariates analyzed were skin, gastrointestinal, and respiratory symptoms; history and demographics at presentation; age at diagnosis and DBPCFC outcomes; sensitization (skin and serum) by cow's milk protein fractions; sensitization to other food and inhalant allergens; total IgE levels; specific IgE concentrations for cow's milk protein fractions, other ingestants, and aeroallergens; and threshold doses at DBPCFC. Sensitization and DBPCFC were performed at 6-month intervals. Results: A total of 112 infants were enrolled (mean [SD] age, 13.85 [9.84] months), and 59 achieved tolerance (mean [SD] age when tolerance was achieved, 27.58 [11.81] months). On univariate analysis, asthma and/or rhinitis at presentation was an independent predictor of persistence (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.26-3.82). On multivariate analysis, predictors of persistence were a fresh milk wheal diameter increment of 1 mm (HR, 1.18; 95% CI, 1.07-1.31) and a positive skin prick test result with soy (HR, 6.99; 95% CI, 1.56-31.25). Conclusions: This is the first study, to our knowledge, to identify incremental biological predictors of delayed tolerance to cow's milk in children that should be integrated into DBPCFC schedules for CMA in infants.

Original languageEnglish
Pages (from-to)166-173
Number of pages8
JournalAnnals of Allergy, Asthma and Immunology
Volume101
Issue number2
Publication statusPublished - Aug 2008

Fingerprint

Milk Hypersensitivity
Cohort Studies
Referral and Consultation
Food
Placebos
Milk Proteins
Confidence Intervals
Immunoglobulin E
Milk
Skin
Rhinitis
Skin Tests
Proportional Hazards Models
Allergens
Appointments and Schedules
Multivariate Analysis
Asthma
History
Demography
Serum

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals : The Milan Cow's Milk Allergy Cohort study. / Fiocchi, Alessandro; Terracciano, Luigi; Bouygue, Gabriel R.; Veglia, Fabrizio; Sarratud, Teresita; Martelli, Alberto; Restani, Patrizia.

In: Annals of Allergy, Asthma and Immunology, Vol. 101, No. 2, 08.2008, p. 166-173.

Research output: Contribution to journalArticle

Fiocchi, Alessandro ; Terracciano, Luigi ; Bouygue, Gabriel R. ; Veglia, Fabrizio ; Sarratud, Teresita ; Martelli, Alberto ; Restani, Patrizia. / Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals : The Milan Cow's Milk Allergy Cohort study. In: Annals of Allergy, Asthma and Immunology. 2008 ; Vol. 101, No. 2. pp. 166-173.
@article{21b8268a483846da82a517dfa9ae595a,
title = "Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals: The Milan Cow's Milk Allergy Cohort study",
abstract = "Background: The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally. Objective: To prospectively determine prognostic predictors of tolerance in a random cohort of referrals using CMA workup outcomes as covariates and tolerance as the status variable in a duration model of CMA. Methods: The 2001-2006 Milan Cow's Milk Allergy Cohort (MiCMAC) enrolled children referrals using double-blind, placebo-controlled food challenges (DBPCFCs) as study end points (confirmation of CMA; onset of tolerance). The Cox regression model was used to analyze all clinical factors that contributed to tolerance. Covariates analyzed were skin, gastrointestinal, and respiratory symptoms; history and demographics at presentation; age at diagnosis and DBPCFC outcomes; sensitization (skin and serum) by cow's milk protein fractions; sensitization to other food and inhalant allergens; total IgE levels; specific IgE concentrations for cow's milk protein fractions, other ingestants, and aeroallergens; and threshold doses at DBPCFC. Sensitization and DBPCFC were performed at 6-month intervals. Results: A total of 112 infants were enrolled (mean [SD] age, 13.85 [9.84] months), and 59 achieved tolerance (mean [SD] age when tolerance was achieved, 27.58 [11.81] months). On univariate analysis, asthma and/or rhinitis at presentation was an independent predictor of persistence (hazard ratio [HR], 2.19; 95{\%} confidence interval [CI], 1.26-3.82). On multivariate analysis, predictors of persistence were a fresh milk wheal diameter increment of 1 mm (HR, 1.18; 95{\%} CI, 1.07-1.31) and a positive skin prick test result with soy (HR, 6.99; 95{\%} CI, 1.56-31.25). Conclusions: This is the first study, to our knowledge, to identify incremental biological predictors of delayed tolerance to cow's milk in children that should be integrated into DBPCFC schedules for CMA in infants.",
author = "Alessandro Fiocchi and Luigi Terracciano and Bouygue, {Gabriel R.} and Fabrizio Veglia and Teresita Sarratud and Alberto Martelli and Patrizia Restani",
year = "2008",
month = "8",
language = "English",
volume = "101",
pages = "166--173",
journal = "Annals of Allergy, Asthma and Immunology",
issn = "1081-1206",
publisher = "American College of Allergy, Asthma and Immunology",
number = "2",

}

TY - JOUR

T1 - Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals

T2 - The Milan Cow's Milk Allergy Cohort study

AU - Fiocchi, Alessandro

AU - Terracciano, Luigi

AU - Bouygue, Gabriel R.

AU - Veglia, Fabrizio

AU - Sarratud, Teresita

AU - Martelli, Alberto

AU - Restani, Patrizia

PY - 2008/8

Y1 - 2008/8

N2 - Background: The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally. Objective: To prospectively determine prognostic predictors of tolerance in a random cohort of referrals using CMA workup outcomes as covariates and tolerance as the status variable in a duration model of CMA. Methods: The 2001-2006 Milan Cow's Milk Allergy Cohort (MiCMAC) enrolled children referrals using double-blind, placebo-controlled food challenges (DBPCFCs) as study end points (confirmation of CMA; onset of tolerance). The Cox regression model was used to analyze all clinical factors that contributed to tolerance. Covariates analyzed were skin, gastrointestinal, and respiratory symptoms; history and demographics at presentation; age at diagnosis and DBPCFC outcomes; sensitization (skin and serum) by cow's milk protein fractions; sensitization to other food and inhalant allergens; total IgE levels; specific IgE concentrations for cow's milk protein fractions, other ingestants, and aeroallergens; and threshold doses at DBPCFC. Sensitization and DBPCFC were performed at 6-month intervals. Results: A total of 112 infants were enrolled (mean [SD] age, 13.85 [9.84] months), and 59 achieved tolerance (mean [SD] age when tolerance was achieved, 27.58 [11.81] months). On univariate analysis, asthma and/or rhinitis at presentation was an independent predictor of persistence (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.26-3.82). On multivariate analysis, predictors of persistence were a fresh milk wheal diameter increment of 1 mm (HR, 1.18; 95% CI, 1.07-1.31) and a positive skin prick test result with soy (HR, 6.99; 95% CI, 1.56-31.25). Conclusions: This is the first study, to our knowledge, to identify incremental biological predictors of delayed tolerance to cow's milk in children that should be integrated into DBPCFC schedules for CMA in infants.

AB - Background: The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally. Objective: To prospectively determine prognostic predictors of tolerance in a random cohort of referrals using CMA workup outcomes as covariates and tolerance as the status variable in a duration model of CMA. Methods: The 2001-2006 Milan Cow's Milk Allergy Cohort (MiCMAC) enrolled children referrals using double-blind, placebo-controlled food challenges (DBPCFCs) as study end points (confirmation of CMA; onset of tolerance). The Cox regression model was used to analyze all clinical factors that contributed to tolerance. Covariates analyzed were skin, gastrointestinal, and respiratory symptoms; history and demographics at presentation; age at diagnosis and DBPCFC outcomes; sensitization (skin and serum) by cow's milk protein fractions; sensitization to other food and inhalant allergens; total IgE levels; specific IgE concentrations for cow's milk protein fractions, other ingestants, and aeroallergens; and threshold doses at DBPCFC. Sensitization and DBPCFC were performed at 6-month intervals. Results: A total of 112 infants were enrolled (mean [SD] age, 13.85 [9.84] months), and 59 achieved tolerance (mean [SD] age when tolerance was achieved, 27.58 [11.81] months). On univariate analysis, asthma and/or rhinitis at presentation was an independent predictor of persistence (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.26-3.82). On multivariate analysis, predictors of persistence were a fresh milk wheal diameter increment of 1 mm (HR, 1.18; 95% CI, 1.07-1.31) and a positive skin prick test result with soy (HR, 6.99; 95% CI, 1.56-31.25). Conclusions: This is the first study, to our knowledge, to identify incremental biological predictors of delayed tolerance to cow's milk in children that should be integrated into DBPCFC schedules for CMA in infants.

UR - http://www.scopus.com/inward/record.url?scp=49449090117&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49449090117&partnerID=8YFLogxK

M3 - Article

VL - 101

SP - 166

EP - 173

JO - Annals of Allergy, Asthma and Immunology

JF - Annals of Allergy, Asthma and Immunology

SN - 1081-1206

IS - 2

ER -