Predictive Factors for Oral Immune Modulation in Cow Milk Allergy

Nutrients. 2022 Jan 23;14(3):494. doi: 10.3390/nu14030494.


Aim: The present study analyzed clinical and biological factors that might predict achievement of tolerance in patients with IgE-mediated cow milk allergy (CMA).

Method: Seventy patients with IgE-mediated CMA (44.24 ± 24.16 months) were included in the study. The patients were evaluated clinically through skin prick test and sIgE to whole milk, casein, beta-lactoglobulin and alpha-lactalbumin. An eviction diet of 6 months was established, followed by oral food challenge test (OFC) and oral immunotherapy (OIT) with baked milk for 6 months. The tolerance was assessed after 2 years follow up.

Results: Thirty percent of patients presented anaphylaxis of different degrees of severity as first manifestation of CMA. Sixty-two patients followed OIT or an accelerated reintroduction of milk. Ten patients (14.28%) did not obtain tolerance to milk within 2 years. A larger wheal in SPT and higher sIgE to milk, casein and betalactoglobulin were noted in patients with positive OFC. A basal level of <2.5 kU/l for sIgE to milk and <11.73 kU/l for sIgE to caseins predicted the occurrence of tolerance in patients with all types of clinical manifestations, including anaphylaxis.

Conclusion: Basal levels of sIgE to milk and casein may help to identify patients that could become tolerant to milk.

Keywords: casein; cow milk allergy; oral immunotherapy; oral tolerance.

MeSH terms

  • Animals
  • Caseins
  • Cattle
  • Female
  • Humans
  • Immune Tolerance
  • Lactoglobulins
  • Milk
  • Milk Hypersensitivity*


  • Caseins
  • Lactoglobulins