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Inicio Allergologia et Immunopathologia Predictors of a positive oral food challenge to cow's milk in children sensi...
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Original Article
DOI: 10.1016/j.aller.2020.03.007
Available online 11 May 2020
Predictors of a positive oral food challenge to cow's milk in children sensitized to cow's milk
R. Ayats-Vidal
Corresponding author
, L. Valdesoiro-Navarrete, M. García-González, O. Asensio-De la Cruz, H. Larramona-Carrera, M. Bosque-García
Paediatric Allergies, Immunology and Pneumology Unit, Paediatric Medicine Service, Parc Tauli University Hospital of Sabadell, Barcelona, Spain
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Tables (3)
Table 1. Patients’ characteristics.
Table 2. Total IgE, specific IgE, and wheal size on skin prick test in children with positive versus negative oral food challenges to whole milk.
Table 3. Area under the curve, cut-off points, sensitivity, and specificity for predictive variables for cow's milk allergy.
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Introduction and objectives

The diagnosis of IgE-mediated cow's milk allergy (CMA) is often based on clinical history and on specific IgE levels and/or skin-prick tests (SPT), both of which are sensitive but not specific. The gold standard, oral food challenge (OFC), is expensive and time-consuming and involves a risk of severe allergic reactions. This study aimed to determine the value of specific IgEs, ratios of specific IgEs for cow's milk and its components to total IgE, and wheal size on SPT for predicting a positive OFC for CMA.

Material and methods

We retrospectively studied 72 patients [median age, four years; age range 0.75–15 years] sensitized to cow's milk who underwent OFCs to milk. predictive variables between patients with positive and negative OFCs were compared. Receiver operator characteristic (ROC) curves were uses to assess variables’ discriminatory capacity and Youden's index to determine the best cut-offs for predicting CMA.


The OFC was positive in 39 (54%) patients. Wheal size on SPT and all specific IgEs and specific-to-total IgE ratios were significantly different between patients with positive OFCs and those with negative OFCs (p<0.001). The variable with the greatest area under the ROC curve was casein-specific IgE (0.98), followed by β-lactoglobulin-specific IgE (0.923), casein-specific-to-total-IgE ratio (0.919), and α-lactalbumin-specific IgE (0.908). Casein-specific IgE ≥0.95kU/L yielded 88.9% sensitivity and 90.9% specificity.


In our center, casein-specific IgE >0.95kU/L can obviate an OFC to cow's milk for the diagnosis of CMA in patients sensitized to cow's milk with a compatible history.

Cow's milk allergy
Food allergy
Specific immunoglobulin E
Oral food challenge
Skin-prick test


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