D1.192 - Natural Course and Predictors of Cow’s Milk Allergy Resolution in an Asian Pediatric Cohort: Data from a Tertiary Care Center

Cow’s milk allergy (CMA) is a common food allergy among infants worldwide. Its natural course and predictors of tolerance may vary across populations due to differences in genetics, environment, and dietary habits. In the Asian population, where dietary exposures differ from Western countries, understanding CMA resolution provides valuable insights.

We conducted a retrospective cohort study of children diagnosed with CMA between 2015 and 2025 at a tertiary care center in Thailand. Clinical presentation, feeding history, skin prick test results, specific IgE levels, and age at tolerance acquisition were analyzed.

A total of 110 patients were included, comprising 98 with IgE-mediated or mixed-type CMA and 12 with non-IgE-mediated CMA. Among the subjects, 53.6% were male, with a median age of reaction onset at 6 months (IQR: 3–10). Most patients (90.3%) were born full-term, and 62.4% were delivered via cesarean section. Cutaneous symptoms were the most common presentation, and 15.5% experienced anaphylaxis at diagnosis. Early cow’s milk exposure within the first 3 days of life was reported in 63.6%. For feeding management, 10.3% were exclusively breastfed with maternal dietary restriction. The most common alternative formula was casein-based extensively hydrolyzed (37.4%), followed by soy (28%), whey-based extensively hydrolyzed (14%), and amino acid-based (10.3%). Most patients (70%) developed tolerance by 30 months (IQR: 20–48). All cases of non-IgE-mediated CMA achieved tolerance by 21 months (IQR: 16.5–25.5). A baseline cow’s milk-specific IgE level of <1.8 kUA/L was a strong predictor of tolerance acquisition (aOR: 4.75, 95% CI: 1.68-13.43, p = 0.003), whereas anaphylaxis at diagnosis was associated with persistent CMA (aOR: 0.18, 95% CI: 0.05–0.61, p = 0.006).

Seventy percent of CMA patients achieved tolerance by 30 months. Non-IgE-mediated CMA resolved faster and at a higher rate than IgE-mediated and mixed-type CMA. A low baseline milk-specific IgE level served as a strong predictor of resolution, while anaphylaxis was associated with persistent allergy. These findings provide beneficial insights for management strategies of children with CMA.