D3.289 - Tolerance Assessment in Children with IgE-Mediated Cow's Milk Allergy Using Different Cutoff Values of Cow’s Milk Specific IgE

Cow's milk (CM) allergy (CMA) is the most common IgE-mediated food allergy in early childhood. The most reliable method for assessing tolerance in CMA to be performing oral food challenges (OFCs) using widely accepted CM-specific IgE cutoff values.  We investigated the results of OFCs with CM using two commonly used CM-sIgE-cutoff values.

We analyzed the OFC test results based on nationally and internationally proposed CM--sIgE cutoff values in children with IgE-mediated CMA at our department between January 2019 and December 2025. 

Forty-nine patients (59.2% male) had CM-sIgE levels were below the cutoff values suggested by Sampson at the time of the OFC. The median ages of symptom onset and admission were 6 months (interquartile ranges 3–9) and 11 months (6.3–20.4), respectively. The median age at OFC was 25.5 months (16–47.4), with a median CM-sIgE level of 1.2 kU/L (0.2–5.9). Atopic dermatitis (AD) was present in 25 (51%), asthma/wheezing in 7 (14.3%), and allergic rhinitis (AR) in 4 (8.2%) patients. Ten (20.4%) had a positive OFCs. At OFC, 2 (4.1%) patients had anaphylaxis. Skin/mucosal findings were in 8 (16.3%). Among the 45 patients (57.8% male) who underwent OFC according to Yavuz's CM-sIgE cutoff values, the median ages of symptom onset and presentation were 6 months (3–9.5) and 11 months (6.3–22.4), respectively. The median age at OFC was 25.1 months (15.8–44), with a median pre-test CM--sIgE level of 1.2 kU/L (0.2–4.2). Twenty-two (48.9%) patients had AD, 7 (15.6%) had asthma/wheezing, and 4 (8.9%) had AR. Nine patients’ (20%) OFC tests resulted positive; 2 (4.4%) had anaphylaxis, skin/mucosal findings were in 7 (15.5%). Although more patients were eligible for OFC based on the international cutoff value, similar positivity rates were observed with both cutoff values.

Our results indicate that even when the decision to perform OFC is made below the proposed national or international cutoff values for tolerance assessment in childhood IgE-mediated CMA, reactions, including anaphylaxis, may still occur in nearly 20% of patients. There appears to be a need for new cutoff values established with large cohorts for tolerance assessment.