Long-term Outcomes of Children with Cow's Milk Protein Allergy in a Pediatric Allergy Clinic

Aim: This study aimed to assess the clinical features, management, and long-term outcomes of pediatric patients with cow's milk protein allergy (CMPA). Materials and Methods: This is a retrospective study consisting of 246 children with CMPA. Data of the patients were collected from the medical files. Results: 95.8% of patients experienced the first reactions associated with cow's milk (CM) allergy during infancy. Hen's egg (56%) was the most frequent triggering food coexisting with CMPA, and this was followed by tree nuts (6%), wheat (5%) and lentil (3%). During five years of the follow-up period, tolerance occurred in 78.9% of the patients. The optimal cutoff value for CM sIgE to predict the tolerance status for CMPA was 7.39 kU/L with a sensitivity of 87.3% and a specificity of 58.3%, [95% confidence intervals (CI), 0.655-0.859, p<0.001]. IgE-mediated hypersensitivity reactions [odds ratios (OR) 4,369 (95% CI, 2,298-8,308), p<0.001], family history of atopy [OR 2,943 (95% CI, 1,324-6,541), p: 0.008), CM sIgE>7.39 [OR 9,683 (95% CI, 3,947-23,757), p<0.001], casein sIgE >0.56 [OR 6,909 (95% CI, 2,719-17,557), p<0.001], were the predictors for the persistence. Conclusion: This study showed that the majority of the CMPA in children gave rise to clinical manifestations in the infancy period, most of them less than six months of age. The prognosis of the disease was favorable with a spontaneous tolerance developed by the age of three in most patients. IgE-mediated hypersensitivity reactions, a family history of atopy and higher specific IgE values were predictive factors for the long-lasting disease.