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Natural history of cow’s milk allergy: a prospective study in children aged 6 to 12 years
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  • Noriyuki Yanagida,
  • Kei Kubota,
  • Ken-ichi Nagakura,
  • Yuki Ejiri,
  • Sakura Sato,
  • Motohiro Ebisawa
Noriyuki Yanagida
Kokuritsu Byoin Kiko Sagamihara Byoin

Corresponding Author:sagami@foodallergy.jp

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Kei Kubota
Kokuritsu Byoin Kiko Sagamihara Byoin
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Ken-ichi Nagakura
Kokuritsu Byoin Kiko Sagamihara Byoin
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Yuki Ejiri
Kokuritsu Byoin Kiko Sagamihara Byoin
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Sakura Sato
Kokuritsu Byoin Kiko Sagamihara Byoin
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Motohiro Ebisawa
Kokuritsu Byoin Kiko Sagamihara Byoin
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Abstract

Background: Approximately 50–90% of children with immediate-type cow’s milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the tolerance acquisition rate of CMA in children aged 6–12 years. Methods: Children with CMA that persisted until 6 years of age were included. Tolerance acquisition was defined as either passing an oral food challenge with 200 mL of unheated cow’s milk (CM) or consuming CM of any quantity without symptoms. Persistent CMA was defined as fulfilling neither of these criteria by 12 years of age. Children undergoing oral immunotherapy were defined as having persistent CMA. Risk factors associated with persistent CMA were assessed using Cox regression analysis. Results: Of the 123 children analyzed, 60 (49%) had previous CM anaphylaxis, 82 (67%) eliminated CM from their diet, and the median CM-specific immunoglobulin E (sIgE) level was 23.3 kU A/L at 6 years of age. Twenty-five children (20%) acquired tolerance by 9 years of age, and 46 (37%) by age 12. At baseline, higher CM-sIgE levels (hazard ratio: 2.58 [95% confidence interval: 1.62–4.12], optimal cutoff level: 34.4 kU A/L), previous CM anaphylaxis (2.42 [1.24–4.69]), and complete CM elimination (5.18 [2.45–10.99]) were associated with persistent CMA. None of the children with CMA who had all three risk factors (n = 26) acquired tolerance. Conclusion: At least one-third of the children with CMA at 6 years of age acquired tolerance by 12 years of age. Children with CMA who have the risk factors are less likely to acquire tolerance.
27 Jul 2023Submitted to Pediatric Allergy and Immunology
27 Jul 2023Submission Checks Completed
27 Jul 2023Assigned to Editor
27 Jul 2023Review(s) Completed, Editorial Evaluation Pending
03 Aug 2023Reviewer(s) Assigned
21 Aug 2023Editorial Decision: Revise Major
30 Oct 20231st Revision Received
30 Oct 2023Submission Checks Completed
30 Oct 2023Assigned to Editor
30 Oct 2023Review(s) Completed, Editorial Evaluation Pending
30 Oct 2023Reviewer(s) Assigned