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Zagazig University Medical Journal
Zagazig University; Faculty of Medicine
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Abstract: |
Cow’s Milk protein allergy (CMA) is a common finding in infants and young children (2-3%).
Its diagnosis is a multifaceted aspect including medical history, clinical examination, diagnostic
elimination diets, oral challenge tests (OCT), skin prick tests (SPTs) and specific
immunoglobulin E (sIgE) measurements. We aimed to assess the value of SPT and sIgE for
diagnosis of infants with CMA in routine clinical practice. This cross sectional study included
102 infants with suspected CMA. They were subjected to OCT, SPT with pasteurized cow's
milk and measurement of serum sIgE for cow’s milk by immunoblot technique. Seventy-two
infants (70.59%) showed positive allergic reactions with OCT. Comparing SPT to OCT,
sensitivity was 75%, specificity was 68.7%, predictive value for negative (PVN) was 59% and
predictive value for positive (PVP) was 93.1%. Comparing sIgE to OCT, sensitivity was 68.1%,
specificity was 96.7%, PVN was 69% and PVP was 98%. Comparing both SPT and sIgE
together to OCT, sensitivity was 62.5%, specificity was 96.6%, PVN was 51.8% and PVP was
97.8%. For clinical practice, our findings suggest that correlation between SPT and sIgE is
significant regarding CMA diagnosis. Therefore, these tests can be used together for diagnosis
of CMA. However, still some cases can be only diagnosed with positive OCT with nondetectable sensitization. Therefore, a detailed history is a major factor in assessing CMA. In
addition, definition of new optimal cut-offs for sIgE and SPT to cow’s milk can improve the
accuracy of these tests, hoping to avoid unnecessary and potentially dangerous OTC.
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