D1.70 - IgE-sensitization to allergens in plant-based drinks in children with cow’s milk allergy
Background
Cow’s milk allergy (CMA) effects about 0.5-3 % of children. Plant-based drinks are often used as milk alternatives, especially after infancy. However, they often contain potential food allergens.
Aim: The aim was to determine the sensitization rate to pea, soy, almond and cashew in children with CMA, as these allergens are often used in plant-based milk alternatives.
Method
In children with challenged-proven CMA, serum-specific IgE (sIgE) was measured to pea, soy, almond and cashew extracts, as well as to the cashew 2S albumin Ana o 3, using the NOVEOSTM immunoanalyzer.
Results
Sera of 125 children (62 % males) with an age range from 8 months to 15 years (median age 15 months) with challenge-proven IgE-mediated CMA were analyzed. 92 % of the children had atopic eczema as a comorbidity. Using a cut-off of 0.1 kU/l, 123 of 125 children (98 %) were sensitized against soy, 98 % against almond, 90% against pea, 83 % against cashew and 61% against Ana o 3. The allergen-sIgE levels are found in table 1 for the sensitized patients. 55% of the children were sensitized against all four allergens. In order to determine the probability for a positive cashew food challenge by Ana o 3-sIgE for each patient, the probability curve by Lange et al. (2017) was utilized. Accordingly, 30 patients (24 %) had a 95 % probability of being cashew allergic [Lange et al., 2017].
Reference: Lange L, Lasota L, Finger A, Vlajnic D, Büsing S, Meister J, Broekaert I, Pfannenstiel C, Friedrichs F, Price M, Trendelenburg V, Niggemann B, Beyer K. Ana o 3-specific IgE is a good predictor for clinically relevant cashew allergy in children. Allergy. 2017 Apr;72(4):598-603. doi: 10.1111/all.13050. Epub 2016 Nov 17. PMID: 27644013.
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Table 1 |
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Number of sensitized patients and corresponding serum-specific IgE values per allergen |
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Allergens |
sensitized [n] |
sensitized [%] |
min [kU/l] |
max [kU/l] |
median [kU/l] |
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Soy |
123 |
98.4 |
0.1 |
>100 |
0.47 |
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Almond |
121 |
96.8 |
0.1 |
>100 |
1.19 |
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Pea |
112 |
89.6 |
0.13 |
76.6 |
0.41 |
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Cashew |
102 |
81.6 |
0.1 |
>100 |
1.85 |
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Ana o 3 |
71 |
56.8 |
0.1 |
>100 |
0.96 |
Conclusion
The vast majority of children with CMA were sensitized to cashew, pea, almond and soy. These allergens are commonly used in plant-based milk alternatives. However, although sensitization does not equal clinically relevant food allergy, there seems to be a potential risk for reactivity to plant-based drinks, especially to the ones containing cashew.
