Open Access, Peer-reviewed
pISSN 2288-0402
eISSN 2288-0410
    Allergy Asthma Respir Dis. 2015 Mar;3(2):139-144. Korean.
    Published online Mar 24, 2015.
    https://doi.org/10.4168/aard.2015.3.2.139
    © 2015 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
    Original Article

    Usefulness of casein specific IgE and IgG antibodies to immediate type cow's milk allergy

    Ja Hyun Lim,1 Kyung Uk Jeong,1 Jeong-Min Lee,1 Kyung Eun Lee,2 and Sooyoung Lee1
      • 1Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
      • 2Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.
    • Correspondence to: Sooyoung Lee. Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443-380, Korea. Tel: +82-31-219-5164, Fax: +82-31-219-5169, Email: jsjs@ajou.ac.kr
    Received July 25, 2014; Revised October 15, 2014; Accepted October 15, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

    Abstract

    Purpose

    Cow's milk-specific IgE (CM-IgE) has been proposed as one of the valuable markers for diagnosis of clinical cow's milk (CM) allergy. In this study, we evaluated the additional usefulness of casein-specific IgE (casein-IgE) and IgG (casein-IgG) for the diagnosis of clinical CM allergy.

    Methods

    Fifty-eight subjects, aged from 3 months to 154 months, were enrolled. Thirty-four patients showed immediate-type of clinical CM allergy, and 24 patients were atopic controls. The serum levels of CM-IgE, casein-IgE, and casein-IgG were measured. Patients were divided into 2 groups: those aged under 12 months and those aged 12 months or over. The diagnostic values of each antibody were analyzed and compared using the Mann-Whitney U-test and receiver operating characteristic curves.

    Results

    CM allergy had significantly higher levels of CM-IgE and casein-IgE, and lower levels of casein-IgG/IgE ratio when compared to atopic controls in both age groups (P<0.05). CM-IgE and casein-IgE were shown to be better predictive markers for immediate-type CM allergy in patients under 12 months, while casein-IgG/IgE ratio was a more useful marker in those aged 12 months or over. Considering 100% positive predictive values, cutoff points were 1.04 kU/L for CM-IgE, 0.11 kU/L for casein-IgE, 19.5 for casein-IgG/IgE ratio in patients aged under 12 months, and 7.1 kU/L for CM-IgE, 1.41 kU/L for casein-IgE, 12.51 for casein-IgG/IgE ratio in those aged 12 months or over.

    Conclusion

    CM-IgE, casein-IgE, and casein-IgG/IgE ratio are useful markers for predicting immediate-type CM allergy. Further studies are needed on diagnostic decision points for CM allergy using combination of cutoff values of these 3 markers.

    Keywords
    Milk hypersensitivity; Caseins; Immunoglobulin E; Immunoglobulin G; Anaphylaxis

    Figures

    Fig. 1
    Receiver operating characteristic curve represent sensitivity and specificity of cow's milk and casein antibodies for diagnosing clinical cow's milk allergy aged less than 12 months (A), aged 12 months or over 12 months (B).

    Fig. 2
    Comparison of sensitivity, specificity, positive predictive value and negative predictive value of cow's milk and casein antibodies aged less than 12 months (A), aged 12 months or over 12 months (B).

    Tables

    Table 1
    Characteristics of study subjects

    Table 2
    Cow's milk and casein specific antibodies in subjects aged less than 12 months

    Table 3
    Cow's milk and casein specific antibodies in subjects aged 12 months or over 12 months

    Table 4
    Clinical decision points of cow's milk and casein specific antibodies obtained from receiver operating characteristic curves

    Table 5
    Comparison of cow's milk and casein specific antibodies in subjects aged 12 months or over according to the presence of cow's milk anaphylaxis

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    MeSH Terms
    Anaphylaxis
    Antibodies*
    Caseins*
    Diagnosis
    Humans
    Hypersensitivity
    Immunoglobulin E*
    Immunoglobulin G*
    Milk
    Milk Hypersensitivity*
    ROC Curve
    Metrics
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