Cow's milk allergy as a predictor of bronchial hyperresponsiveness and airway inflammation at school age

Clin Exp Allergy. 2010 Oct;40(10):1491-7. doi: 10.1111/j.1365-2222.2010.03567.x.


Background: Cow's milk allergy (CMA) has been found to be associated with an increased incidence of asthma at school age. However, prospective population-based studies of CMA and the development of airway inflammation and bronchial hyperresponsivess (BHR) are lacking.

Objective: The aims of this study was to evaluate CMA as a risk factor for BHR and airway inflammation presented later in childhood.

Methods: We followed prospectively 118 children with CMA and invited them to a clinical visit at a mean age of 8.6 years including the measurement of exhaled nitric oxide (FE(NO) ) and bronchial challenge with histamine. Ninety-four patients and 80 control subjects from the same cohort participated.

Results: At school age, children with a history of CMA had higher FE(NO) levels (P=0.0009) and more pronounced responsiveness to histamine (P=0.027) than their controls. Stratified analysis showed a significant difference only in IgE-positive CMA. Multinomial logistic regression analysis showed that IgE-positive CMA [odds ratio (OR) 3.51; 95% confidence intervals (CI) 1.56-7.90; P=0.002] and a history of wheeze during the first year of life (OR 2.81; 95% CI 1.16-6.84; P=0.023) were independent explanatory factors for increased FE(NO) , and IgE-positive CMA (OR 3.37; 95% CI 1.03-10.97; P=0.044) and parental smoking (OR 3.41; 95% CI 1.14-10.22; P=0.028) for increased BHR, whereas for IgE-negative CMA, no associations with FE(NO) or BHR were found. In the CMA group, those exposed to CM very early at the maternity hospital, had less BHR (P=0.002).

Conclusions: Compared with their controls, children with a history of IgE-positive CMA show signs of airway inflammation, expressed as higher FE(NO) , and more pronounced bronchial responsiveness to histamine at school age. In contrast to IgE-negative CMA, IgE-positive CMA is a significant predictor of increased FE(NO) and BHR at school age. Very early exposure to CM was associated with less BHR.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bronchial Hyperreactivity / complications*
  • Bronchial Hyperreactivity / immunology
  • Bronchial Provocation Tests
  • Cattle
  • Child
  • Exhalation
  • Female
  • Humans
  • Immunoglobulin E / blood
  • Immunoglobulin E / immunology
  • Infant
  • Infant, Newborn
  • Male
  • Milk / immunology
  • Milk Hypersensitivity / complications*
  • Milk Hypersensitivity / immunology
  • Nitric Oxide / analysis
  • Pneumonia / complications*
  • Pneumonia / immunology
  • Respiratory Function Tests
  • Risk Factors
  • Skin Tests


  • Nitric Oxide
  • Immunoglobulin E