How to optimize cow’s milk and egg allergy diagnosis in primary care?
The important role of specific IgE tests
In primary care, managing cow’s milk and egg allergies effectively can be a challenge. With similar and overlapping symptoms, it can be difficult to accurately identify the triggers and develop an effective management plan.
This article explores ways to optimize the diagnosis and management of these common food allergies, spotlighting the pivotal role of specific IgE tests, and utilizing cutting-edge ImmunoCAP™ technology, to deliver more accurate and informed care.
What is the ImmunoCAPTM Specific IgE test?
The ImmunoCAP test is a precise aid in diagnosing allergies, especially useful for food allergies like cow's milk or egg. It identifies specific allergens triggering allergic reactions, aiding in accurate diagnosis and personalized management plans.
In conjunction with the patient's detailed clinical history and physical examination, testing with the ImmunoCAP Specific IgE test will assist you in the following:
- Developing a personalized allergy management treatment plan.
- Providing comprehensive guidance on allergen avoidance.
- Understanding the likelihood of an allergy disappearing and the possibility of not reacting to certain allergens.
- Referring the right patients to allergology specialists.
- Identifying potential risks of cross-allergic reactions enabling proactive care.
Cow's milk allergy
Epidemiology
Cow’s milk allergy, CMA, stands as the most common childhood allergy, affecting 2-3% of children under the age of 3.1-3
The early onset of sensitization, typically occurring within the first year of life, underscores the significant health concern posed by CMA.3 Studies indicate a resolution rate of around 50% by the age of 10.1-3 CMA can manifest as either IgE or non-IgE mediated reactions.
How to diagnose CMA?
Like any food allergy, diagnosing CMA entails a comprehensive approach, relying on clinical history, physical examinations, and targeted inquiries about food allergies.4, 5
The diagnostic journey is intricate due to the vague nature of symptoms, leading to potential misdiagnoses and subsequent health risks for infants and caregivers.6
Learn more about the common symptoms of cow’s milk allergy.
Clinical suspicion of IgE-mediated CMA is confirmed by demonstrating the presence of allergen-specific IgE antibodies through in vivo (skin tests) or in vitro blood testing. Anyone presenting with allergy symptoms can be a candidate for specific IgE testing.
The ImmunoCAP Specific IgE blood test aids in identifying candidates for an oral food challenge, offering opportunities for personalized care: more precise guidance to broaden dietary options and enhance patient’s quality of life.7, 8
Access the step-by-step guide to cow's milk allergy diagnosis for additional information.
How to test for CMA?
Egg Allergy
Epidemiology
Egg allergy is the second most common food allergy in infants and young children, second only to cow’s milk in prevalence, affecting 0,5-2,5% of them.9-11
It usually presents in the second half of the first year of life, with a median age of presentation of 10 months.9
Resolution of egg allergy is highly associated with lower IgE levels and the absence of systemic reactions beyond skin presentation. Although approximately 50 % of pediatric patients are likely to outgrow their egg allergy by age 6, research suggests that children are outgrowing their egg allergy more slowly than before.11
How to diagnose egg allergy?
Making an accurate diagnosis when evaluating a patient with a possible egg allergy is important to avoid unnecessary dietary restrictions and prevent life-threatening reactions.
The typical diagnostic routine for egg allergy begins with a physical examination and detailed clinical history.4, 5, 12
Find out about common symptoms of egg allergy
In adults and children, subsequent steps of primary diagnosis may involve skin-prick testing or specific IgE testing, such as the ImmunoCAP test, to confirm the diagnosis or assess the need for an oral food challenge. The Specific IgE test leverages egg white extract containing major allergens recognized by egg-allergic individuals, allowing it to be a highly accurate initial diagnostic tool.13
Access the step-by-step guide to egg allergy diagnosis for additional information.
How to test for egg allergy?
In some children allergic to eggs, the allergy may disappear, allowing for the reintroduction of foods containing this allergen into their diet. Therefore, it is recommended to undergo periodic evaluations and oral food challenges to monitor any progress toward the resolution of egg allergy.
What key role is played by General Practitioners?
As a General Practitioner, you play an essential role in the early detection, initial testing for allergen triggers in cow’s milk or egg allergies. Patients want answers and relief, and you want the best tools to deliver. By prescribing a specific IgE blood test, you can identify food allergens impacting patients, making it easier for them to avoid their triggers and live healthier.
Regular follow-ups are recommended, conducting clinical reassessments, and performing testing for example every 6-12 months with the same technique.
By employing these measures, you can tailor personalized management plans, including customized dairy elimination strategies and age-appropriate milk substitutes. This approach not only improves patient outcomes but also reinforces the quality of care provided.
In cases where food allergy diagnosis remains uncertain or requires specialized attention, your collaboration with allergists and clinical immunology professionals ensures that patients receive tailored treatment plans. This collaborative effort contributes to the comprehensive management and well-being of individuals affected by cow’s milk or egg allergies
You have the power to make a difference.
For additional info on ImmunoCAP testing, allergies, and/or educational tools and resources, contact our allergy experts.
Relevant resources
Tools to aid in your diagnosis and patient management.
- Skripak, J. M., Matsui, E. C., Mudd, K. & Wood, R. A. The natural history of IgE-mediated cow’s milk allergy. Journal of Allergy and Clinical Immunology 120, 1172–1177 (2007).
- Savage, J. & Johns, C. B. Food Allergy: Epidemiology and Natural History. Immunology and Allergy Clinics of North America vol. 35 45–59 Preprint at https://doi.org/10.1016/j.iac.2014.09.004 (2015).
- Savage, J., Sicherer, S. & Wood, R. The Natural History of Food Allergy. Journal of Allergy and Clinical Immunology: In Practice 4, 196–203 (2016).
- Kurowski, K. & Boxer, R. W. Food Allergies: Detection and Management. Am Fam Physician 77, (2008).
- Burks, A. W. et al. ICON: Food allergy. Journal of Allergy and Clinical Immunology 129, 906–920 (2012).
- Vandenplas, Y. et al. An ESPGHAN position paper on the diagnosis, management and prevention of cow’s milk allergy. J Pediatr Gastroenterol Nutr (2023) doi:10.1097/mpg.0000000000003897.
- Nowak-Wegrzyn, A. et al. Tolerance to extensively heated milk in children with cow’s milk allergy. Journal of Allergy and Clinical Immunology 122, 342-347.e2 (2008).
- Caubet, J. C. et al. Utility of casein-specific IgE levels in predicting reactivity to baked milk. Journal of Allergy and Clinical Immunology 131, 222-224.e4 (2013).
- Caubet, J. C. & Wang, J. Current understanding of egg allergy. Pediatr Clin North Am 58, 427–443 (2011).
- Savage, J. H., Matsui, E. C., Skripak, J. M. & Wood, R. A. The natural history of egg allergy. J Allergy Clin Immunol 120, 1413–1417 (2007).
- Sicherer, S. H. et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol 133, (2014).
- Kattan, J. D. & Sicherer, S. H. Optimizing the Diagnosis of Food Allergy. Immunology and Allergy Clinics of North America vol. 35 61–76 Preprint at https://doi.org/10.1016/j.iac.2014.09.009 (2015).
- enhamou, A. H. et al. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy: European Journal of Allergy and Clinical Immunology vol. 65 283–289 Preprint at https://doi.org/10.1111/j.1398-9995.2009.02251.x (2010).
- Santos, A. F. et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy: European Journal of Allergy and Clinical Immunology (2023) doi:10.1111/all.15902.
