Cow milk sensitization in a group of egyptian allergic infants and children

Objective: There are no published data on the prevalence of cow's milk (CM) sensitization in Egypt. We sought to screen for cow's milk sensitization in a group of Egyptian allergic infants and young children in relation to their phenotypic data. Methods: We consecutively enrolled 59 patients from the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, and 35 healthy controls. Detailed history was taken for the duration and severity of symptoms, possible precipitating factors, response to treatment and family history of allergy. A clinical examination was conducted to verify the diagnosis and exclude other chronic illness. The study measurements included skin prick testing (SPT) with a commercial cow's milk extract and serum cow's milk specific IgE (CM-IgE) assay. Results: SPT to cow's milk was highly predictive of CMA in 10.2% of the studied sample. CM-IgE was found just positive in 58.5% of the studied sample but none of the subjects had a level that is 95% predictive of CMA. Cow's milk sensitization rates did not vary significantly with gender, age, weight, duration of illness or the target organ affected. There was a positive correlation between the CM-IgE level as an in vitro measure and the CM wheal diameter as an in vivo measure. Also, our study indicated that SPT to cow's milk bore a sensitivity and specificity of 100% in revealing cow's milk sensitization in comparison to 57.62% and 40% respectively for CM-IgE assay. Conclusion: Cow’s milk sensitization rates seem high in our country. Skin prick and specific IgE testing aided by history are good screening tools to determine candidates for cow's milk oral food challenging. Wider scale population-based multicenter studies are needed to assess the prevalence of CM sensitization and its clinical correlates in Egypt.