18. How to identify future tolerance in children with milk allergy
Having introduced the entity of milk allergy or hypersensitivity in the abstract on eosinophilic gastroenteritis, herewith some current concepts relevant to the entity. Although symptoms suggestive of cow's milk protein allergy (CMPA) may be found in up to 15% of infants, the true entity affects only 2-3% of infants in developed countries. Symptoms must be reproducible and confirmed by elimination and challenge procedures in order to make the diagnosis. Most infants become symptomatic within the first month of life (following early introduction of CMP-based formula) and often within 1 week of first exposure. The majority have 2 or more symptoms from 2 or more organ systems (50-60% have cutaneous, 50-60% have G.I., and 20-30% have respiratory symptoms). Up to 50% remit within the first year of life, 75% by 2 years and up to 90% by 3 years. Remission/tolerance rates have also been studied and it has been found that children who have delayed hypersensitivity reactions are more likely to become tolerant than those with immediate reactions (tolerance development was 64%, 92% and 96% at 2, 3 and 4 years in the delayed group vs 31%, 53% and 63% in the immediate reaction group). Lower IgE levels were also of value in identifying the tolerant infants, as was testing with skin-prick kits (smaller wheals in tolerant infants).

Read more:
J Pediatr 2004;144:18-22
Ann Allergy Asthma Immunol 2002;89(Suppl 6):33-7 and pp 86-90 and pp 91-6