ArticlePediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology2025
Casein sIgE as the most accurate predictor for heated milk tolerance in Finnish children.
Article in Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Casein sIgE avidity and milk basophil reactivity in children with cow's milk allergy.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Oral Food Challenges to Milk and Egg in Children: Associations with Skin Prick Tests and IgE Sensitization Profiles.Nutrients · 2026Article
- Does Previous Anaphylaxis Determine Differences Between Patients Undergoing Oral Food Challenges to Cow's Milk and Hen's Egg?Nutrients · 2026Article
- Casein sIgE as the most accurate predictor for heated milk tolerance in Finnish children.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2025Article
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3 authors.
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Abstract
backgroundUp to 83% of children with cow's milk allergy (CMA) tolerate baked milk, but research on heated milk (HM) tolerance and allergen-specific IgE (sIgE) cutoff values predicting oral food challenge (OFC) outcomes are lacking. We hypothesized that casein sIgE is the best predictor for HM tolerance.
methodsFinnish children suspected of having IgE-mediated CMA were recruited. sIgE levels to milk, casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin were measured alongside skin prick tests (SPT) to fresh milk (FM) and HM. The diagnosis was confirmed with an FM OFC. IgE-sensitized children with a positive FM OFC underwent an HM OFC with extensively heated milk in rice porridge. Cutoff values to predict HM OFC outcome were determined, reaction severity analyzed, and effect of age investigated.
resultsOf the 158 children (median age: 2.59 years) undergoing FM OFC, 127 proceeded to an HM OFC. Of these, 77 (61%) demonstrated HM tolerance. Casein sIgE emerged as the best predictor for the HM OFC outcome (AUC 0.786), with a 95% sensitivity cutoff value of <0.54 kU/L and a 95% specificity cutoff value of >14.1 kU/L. Most HM OFC reactions were mild (66%), but reaction severity was unpredictable. Casein sIgE, milk sIgE, and HM SPT showed greater accuracy in ≤3-year-old children.
conclusionCasein sIgE cutoffs <0.54 and >14.1 kU/L can help identify children with a high or low likelihood of HM tolerance. This approach may reduce unnecessary OFCs in high-risk patients and guide safe dietary advancement on a milk ladder in low-risk cases.
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