IgE-mediated cow’s milk protein allergy in Singaporean children
Kok Wee Chong,1 Si Hui Goh,1 Seyed Ehsan Saffari,2 Wenyin Loh,1 Isabel Sia,3 Sherilyn Seah,3 Anne Goh1
1 Allergy Service, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore
2 Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Abstract
Background: Cow’s milk protein allergy (CMA) is the second most common food allergy in Singapore. However, there is limited data on local paediatric CMA.
Objective: We aimed to describe the demographics, clinical characteristics, natural history and diagnostic performance of skin prick test (SPT) and cow’s milk-specific immunoglobulin E (CM-IgE) in Singaporean children diagnosed with IgE-mediated CMA.
Methods: A retrospective review of medical records was conducted for children with an SPT performed to cow’s milk between 2011 and 2016.
Results: There were 355 patients included, 313 cow’s milk allergic and 42 cow’s milk tolerant. The median age of reaction was 6 months (IQR 4-8). The most common allergic presentation was cutaneous reactions, followed by gastrointestinal reactions. Six patients (1.9%) reported anaphylaxis at initial presentation and 16 children (5.1%) experienced anaphylaxis to cow’s milk at least once in their lifetime. Most of the CMA patients (81.8%) acquired natural tolerance by 6 years old. SPT to cow’s milk of ≥ 7 mm and CM-IgE of ≥ 13 kU/L showed good discriminative abilities in predicting a failed oral food challenge (OFC) outcome.
Conclusion: CMA is a food allergy which commonly presents during infancy, and parents need to be aware of the likelihood of severe allergic reactions, including anaphylaxis. Prognosis for CMA is generally favourable. Future prospective cohort studies are required to better understand the natural history and better define the diagnostic cut-off values for allergy testing in our population.
Key words: anaphylaxis, cow’s milk protein allergy, IgE-mediated food allergy, natural history, Singaporean children,