2009, Number 3
Alerg Asma Inmunol Pediatr 2009; 18 (3)
Cadena-León JF, Cervantes-Bustamante R, Montijo-Barrios E, Hernández-Bautista V, Zárate-Mondragón F, Díaz-Madero S, Ramírez-Mayans JA
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ABSTRACTApproximately 5 to 15% of infants present an adverse reaction to formulas containing cow´s-milk protein, but only 2 -3% can be diagnosed by IgE-mediated response tests. T cell mediated hypersensitivity reactions against cow´s-milk protein have been described, although the precise mechanisms have not been completely eluded. The double-blind, placebo-controlled cow´s milk protein challenge test is still considered the gold standard for the diagnosis. Aim: To value the diagnostic sensitivity, specificity and predictive value of the different tests for cow´s milk protein allergy/hypersensitivity in children up 36 months of age. Methods: A qualitative review of randomized controlled trials, retrospective studies, cohorts and reviews was performed. We searched articles published between 1996 to 2006 that evaluated the diagnostic value of cow´s milk protein allergy in infants (age ‹ 2 years) using MEDLINE, PubMed, EMBASE, DARE, Bandolier, OVID, Science-Direct, EBSCO, LILACS , ARTEMISA and IMBIOMED. The Jovell scale was used to assess the quality of the publications. Results: IgE-mediated reaction tests: skin and prick tests have a sensitivity of 43-72% and a specificity of 62-91% when the reaction is › 3 mm. RAST › 5KU/L has a sensitivity of 49-88% and a specificity of 58-90%. The patch test (cell mediated) has a sensitivity of 44.8% and a specificity of 93.8%. Lymphocyte proliferation tests have no value. TNF alfa, IL-4, IL-5 and IL-13 might have a role to determine the underlying mechanisms involved in the allergic/hypersensitivity reaction. Conclusions: There is no single diagnostic test for cow´s milk protein allergy/hypersensitivity. The double-blind, placebo-controlled cow´s milk protein challenge test is still considered the gold standard.