Schoemaker AA, Sprikkelman AB, Grimshaw KE, Roberts G, Grabenhenrich L, Rosenfeld L, Siegert S, Dubakiene R, Rudzeviciene O, Reche M, Fiandor A, Papadopoulos NG, Malamitsi-Puchner A, Fiocchi A, Dahdah L, Sigurdardottir ST, Clausen M - 46651 N - Allergy 2015 ; in press

Incidence and natural history of challenge-proven cow's milk allergy in European children -EuroPrevall birth cohort

BACKGROUND: Cows milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria.

METHODS: Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows’ milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge.

RESULTS: Across Europe 12,049 children were enrolled, 9,336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in Netherlands and UK) to less than 0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cows milk specific IgE in serum, especially those from UK, Netherlands, Poland and Italy. Of children with CMA who were reevaluated one year after diagnosis 69% (22/32) tolerated cow’s milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA.

CONCLUSIONS: This unique pan-European birth cohort study using the gold-standard diagnostic procedure for food allergies confirmed challenge-proven CMA in less than 1% of children up to age 2. Affected infants without detectable specific antibodies to cows milk were very likely to tolerate cows milk one year after diagnosis, whereas only half of those with specific antibodies in serum “outgrew” their disease so soon. This article is protected by copyright. All rights reserved.