Epidemiology of Cow’s Milk Allergy
Abstract
:1. Introduction
2. Subtypes of Immune-Mediated Reactions to Cow’s Milk
3. Diagnosis of CMA
4. Prevalence of CMA
4.1. Prevalence of IgE-Mediated CMA: Meta-Analysis and Systematic Reviews
4.2. Prevalence of IgE-Mediated CMA: Select Studies
4.3. Patterns of CMA Prevalence Over Time
5. Natural History of CMA
6. Factors Associated with Resolution
7. Severity
8. Nutritional and Growth Concerns
9. Risk Factors for CMA
10. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
95% CI | 95% Confidence Interval |
CoFAR | Consortium for Food Allergy Research |
CMA | Cow’s Milk Allergy |
DBPCFC | Double Blind, Placebo-Controlled Oral Food Challenge |
FPIES | Food Protein Induced Enterocolitis Syndrome |
IgE | Immunoglobulin E |
MACS | Melbourne Atopy Cohort Study |
Mm | Millimeter |
NHANES | National Health and Nutrition Examination Survey |
OFC | Unblinded Oral Food Challenge |
OR | Odds Ratio |
sIgE | Serum-specific IgE (sIgE) |
SPT | Skin Prick Test |
US | United States |
WHEALS | Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study |
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Methodological Issue | |
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Variation in Reaction Types and Misclassification |
|
Study design |
|
Assessment of allergy |
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Diagnostic methods and distinguishing between sensitization and clinical allergy |
|
Study population |
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Variations in phenotype |
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Natural history |
|
(A) | |||
Authors | Methods | Prevalence of IgE-Mediated Food Allergy | |
Nwaru et al. [27] | Systematic review and meta-analysis of European studies published between 2000 and 2012 (includes 42 primary articles on CMA) | Self-report: 2.3% (95% CI 2.1%,2.5%) SPT alone: 0.3% (95% CI 0.03%,0.6%) sIgE alone: 4.7% (95% CI 4.2%,5.1%) Food challenge: 0.6% (95% CI 0.5%,0.8%) Positive Food challenge or history of reaction: 1.6% (95% CI 1.2%,1.9%). | |
Rona et al. [3] | Meta-analysis of papers on food allergy published from January 1990 to December 2005 | Prevalence Range Self-report: 1.2%–17% SPT alone: 0.2%–2.5% sIgE alone: 2%–9% Symptoms and sensitization: 0%–2.0% Food challenge: 0%–3.0%. | |
(B) | |||
Cohort | n Age group | Prevalence of IgE-mediated CMA | |
EuroPrevall cohort [28] | n = 12049 enrolled n = 9336 followed to age 2Children | Adjusted incidence: 0.59% (adjusted for loss to follow-up/those not challenged/placebo reactors) Natural History: 57% developed tolerance within 1 year Food allergy determined by (1) DBPCFC with sensitization on testing and no regular consumption of cow’s milk or (2) history of reaction or improvement with elimination | |
NHANES III (1988–1994) and NHANES 2005–2006 [36] | NHANES III n = 4995 NHANES 2005–2006 n = 2901 Children (age 6–19) | Prevalence of sensitization to cow’s milk - Overall (sIgE ≥ 0.35): NHANESIII: 8.3% (95% CI 7.0%,9.8%); NHANES 2005–2006: 8.1% (95% CI 6.1%,10.2%) - Moderate-level (IgE ≥ 2 kU/L): NHANESIII: 0.4% (95% CI 0.1%,0.7%); NHANES 2005–2006: 0.5% (95% CI 0.1%,0.9%) - High-level (IgE ≥ 15, 95% predictive probability cut-off): NHANESIII: 0%; NHANES 2005–2006: 0.008% (95% CI −0.01%,0.03%) | |
NHANES 2005–2006 [32] | n = 8203 All ages | Sensitization Overall = 5.7% By Age 1–5 year = 22.0% 6–19 year = 8.1% 20–39 year = 3.2% 40–59 year = 4.9% ≥60 = 3.8% | Estimated Clinical Food Allergy Rate Overall = 0.40% By Age 1–5 year = 1.8% 6–19 year = 0.26% 20–39 year = 0.16% 40–59 year = 0.49% ≥60 = 0.33% |
Melbourne, Australia High risk cohorts (first degree family history of atopy) [37] | Melbourne Atopy Cohort Study (MACS) (born 1990–1994), n = 620 High-risk subset of HealthNuts Study (born 2006–2010), n = 3661 Children | Prevalence of sensitization (SPT) MACS 2.4% (95% CI 1.6%,3.1%) HealthNuts 2.6% (95% CI 2.0%,3.4%) | |
US Cross-sectional Telephone Survey of children (2009–2010) [7] | n = 38,380 Children | Prevalence of self-reported CMA 1.7% (95% CI = 1.5,1.8) | |
US Internet/Telephone Survey of adults (2015–2016) [34] | n = 40,443 Adults | Prevalence of self-reported CMA 1.9% (95% CI = 1.8%,2.1%) | |
NHANES 2007–2010 [33] | n = 20,686 All ages | Prevalence of self-reported CMA Children: 1.94% (95% CI = 1.43, 2.44) Adults: 2.64% (95% CI = 2.15, 3.13) Prevalence in adults and children excluding those with ingestion = 1.62% (95% CI = 1.32%, 1.92%) | |
New York City Urban Population (1997–2007) [52] | Retrospective chart review n = 9184 Median age 7 years, range 0–21 years | Prevalence of physician documented CMA = 0.5% (0.3% excluding those with no specific symptoms and no confirmatory testing) | |
Israel, average-risk population (born 2004–2006) [29] | n = 13,019 Enrolled at birth and followed through age 3–5 year | Cumulative incidence of CMA diagnosis = 0.5% | |
Denmark birth cohort (born 1985) [31] | n = 1749 Enrolled at birth | Incidence Age 1 y = 2.2% (95% CI = 1.5%,2.9%) Incidence Age 1 y confirmed by OFC = 0.5% (95% CI = 0.2%,0.9%) | |
US Cross-sectional study of children (2009–2010) [60] | n = 3218 | Prevalence = 1.6% (95% CI = 1.4%,1.7%) |
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Flom, J.D.; Sicherer, S.H. Epidemiology of Cow’s Milk Allergy. Nutrients 2019, 11, 1051. https://doi.org/10.3390/nu11051051
Flom JD, Sicherer SH. Epidemiology of Cow’s Milk Allergy. Nutrients. 2019; 11(5):1051. https://doi.org/10.3390/nu11051051
Chicago/Turabian StyleFlom, Julie D., and Scott H. Sicherer. 2019. "Epidemiology of Cow’s Milk Allergy" Nutrients 11, no. 5: 1051. https://doi.org/10.3390/nu11051051