Background: Bottle-fed infants sometimes develop intestinal cow’s milk allergy (ICMA). Because cow’s milk-specific IgE antibody (CM-IgE) levels are normal, the lymphocyte stimulation test (LST) has been proposed as an alternative diagnostic test for ICMA. The present study evaluated the diagnostic value of LST in a large number of patients with ICMA in Japan. Methods: Ninety-six infants who developed intestinal symptoms after ingestion of cow’s milk formula and showed remission of symptoms after elimination of this food were enrolled as patients with probable ICMA. Seventy-two subjects with normal CM-IgE levels and a positive result in an oral food challenge test (OFCT) for cow’s milk formula were diagnosed with ICMA. Another 10 infants with normal CM-IgE levels and a negative OFCT result were diagnosed with nonspecific intestinal symptoms (NIS). The status of cell-mediated immunity against cow’s milk proteins was estimated by LST for ĸ-casein. Results: In the 72 patients with ICMA (38 boys and 34 girls), the median age at onset was 9 days. Sixty-two of 72 (86.1%) patients with ICMA tested positive in the LST for ĸ-casein. In contrast, only 2 of the 10 NIS infants tested positive. The incidence of a positive LST result was significantly higher in the ICMA group than in the NIS group (p < 0.0001). The area under the receiver-operating characteristic curve for this test was as high as 0.856. Conclusions: This study strongly suggests that the LST for ĸ-casein is a useful diagnostic test for ICMA.

Keywords:
Cow’s milk allergy, Infants, Cell-mediated hypersensitivity, Lymphocyte stimulation test, ĸ-Casein
1.
Host A: Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol 1994;5(suppl):1–36.
2.
Goldman AS, Anderson DW, Sellers WA, Saperstein S, Kniker WT, Halpern SR: Milk allergy-I. Oral challenge with milk and isolated milk proteins in allergic children. Pediatrics 1963;32:425–443.
3.
Gryboski JD: Gastrointestinal milk allergy in infants. Pediatrics 1967;40:354–362.
4.
Powell GK: Food protein-induced enterocolitis of infancy: differential diagnosis and management. Compr Ther 1986;12:28–37.
5.
Sicherer SH, Eigenmann PA, Sampson HA: Clinical features of food protein-induced enterocolitis syndrome. J Pediatr 1998;133:214–219.
6.
Miyazawa T, Itabashi K, Imai T: Management of neonatal cow’s milk allergy in high-risk neonates. Pediatrics Int 2009;51:544–547.
7.
Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM: Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol 2006;17:351–355.
8.
Van Sickle, Powell GK, McDonald PJ, Goldblum RM: Milk- and soy protein-induced enterocolitis: evidence for lymphocyte sensitization to specific food proteins. Gastroenterology 1985;88:1915–1921.
9.
Shek LP, Bardina L, Castro R, Sampson HA, Beyer K: Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and non-IgE-mediated disorders. Allergy 2005;60:912–919.
10.
Sicherer SH, Sampson HA: Food allergy. J Allergy Clin Immunol 2010;125:S116–S125.
11.
Hoffman KM, Ho DG, Sampson HA: Evaluation of the usefulness of lymphocyte proliferation assays in the diagnosis of allergy to cow’s milk. J Allergy Clin Immunol 1997;99:360–366.
12.
Kimura M, Tsuruta S, Yoshida T: Correlation of house dust mite-specific lymphocyte proliferation with IL-5 production, eosinophilia, and the severity of symptoms in infants with atopic dermatitis. J Allergy Clin Immunol 1998;101:84–89.
13.
Mattern T, Thanhauser A, Reiling N, Toellner KM, Duchrow M, Kusumoto S, Rietschel ET, Ernst M, Brade H, Flad H-D, Ulmer AJ: Endotoxin and lipid A stimulate proliferation of human T cells in the presence of autologous monocytes. J Immunol 1994;153:2996–3004.
14.
Brix S, Bovetto L, Fritsche R, Barkholt V, Frokiaer H: Immmunostimulatory potential of β-lactoglobulin preparations: effects caused by endotoxin contamination. J Allergy Clin Immunol 2003;112:1216–1222.
15.
Powell GK: Milk- and soy-induced enterocolitis of infancy. Clinical features and standardization of challenge. J Pediatr 1978;93:553–560.
16.
Nowak-Węgrzyn, Muraro A: Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 2009;9:371–377.
17.
Werfel T, Ahlers G, Schmidt P, Boeker M, Kapp A: Detection of a kappa-casein-specific lymphocyte response in milk-responsive atopic dermatitis. Clin Exp Allergy 1996;26:1380–1386.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.