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

Ja Hyun Lim; Kyung Uk Jeong; Jeong-Min Lee; Kyung Eun Lee; Sooyoung Lee

doi:10.4168/aard.2015.3.2.139

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Lim, Jeong, Lee, Lee, and Lee: Usefulness of casein specific IgE and IgG antibodies to immediate type cow's milk allergy

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(2): 139-144.

Published online: 24 March 2015

DOI: https://doi.org/10.4168/aard.2015.3.2.139

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

Ja Hyun Lim¹, Kyung Uk Jeong¹, Jeong-Min Lee¹, Kyung Eun Lee², 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, jsjs@ajou.ac.kr

Received 25 July 2014 Revised 15 October 2014 Accepted 15 October 2014

(open-access):

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 and Tables

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).

Table 1

Characteristics of study subjects

Characteristic	Total (n = 58)	Cow's milk allergy (n = 34)	Other allergy (n = 24)
Age (mo)
3-11	17	9	8
12-23	17	9	8
24-35	8	5	3
36-49	4	3	1
48-71	6	3	3
72-154	6	5	1
Sex
Male	37	21	16
Female	21	13	8
Symptom
Urticaria	25	15	10
Angioedema	8	7	1
Anaphylaxis	12	12	0
Atopic dermatitis	37	19	18
Allergic rhinitis	1	0	1

Table 2

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

Variable	Cow's milk allergy (n = 9)	Other allergy (n = 8)	P-value
Cow's milk IgE (kU/L)	6.8 ± 11.8	0.1 ± 0.1	0.001
Casein IgE (kU/L)	6.4 ± 11.4	0.05 ± 0.01	0.003
Casein IgG (kU/L)	11.7 ± 10.0	40.3 ± 55.5	0.228
Casein IgG/IgE	23.3 ± 54.6	646.5 ± 782.5	0.016

Values are presented as mean±standard deviation.

Table 3

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

Variable	Cow's milk allergy (n = 34)	Other allergy (n = 24)	P-value
Cow's milk IgE (kU/L)	16.5 ± 19.3	0.8 ± 1.7	< 0.001
Casein IgE (kU/L)	15.2 ± 17.9	0.2 ± 0.4	< 0.001
Casein IgG (kU/L)	11.9 ± 11.7	34.9 ± 36.3	0.002
Casein IgG/IgE	15.7 ± 39.2	278.5 ± 287.4	< 0.001

Values are presented as mean±standard deviation.

Table 4

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

Variable	100% NPV		100% PPV
Variable	Age<12 mo	Age≥12 mo	Age<12 mo	Age≥12 mo
Cow's milk IgE (kU/L)	≤0.18	≤0.05	≥1.04	≥7.10
Casein IgE (kU/L)	≤0.07	≤0.05	≥0.11	≥1.41
Casein IgG/IgE	≥432.00	≥167.60	≤19.50	≤12.51

NPV, negative predictive value; PPV, positive predictive value.

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

Variable	Cow's milk anaphylaxis (n=10)	No anaphylaxis (n=15)	P-value
Cow's milk IgE (kU/L)	23.6±20.3 (2.25-67.9)	11.7±17.5 (0.05-63.8)	0.009
Casein IgE (kU/L)	23.3±18.9 (1.41-59.7)	9.8±15.3 (0.05-59.3)	0.019
Casein IgG (kU/L)	12.2±9.3 (2.86-26.7)	11.5±13.6 (2.68-51.2)	0.682
Casein IgG/IgE	1.0±0.9 (0.15-2.76)	25.5±48.7 (0.32-130.0)	0.038

Values are presented as mean±standard deviation (range).

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