Cow's milk allergy (CMA) accounts for most diagnosed food allergies, mainly in the first year of life.1CMA can cause severe anaphylaxis.2 CMA management is based on strict avoidance and the prescription of rescue medication.
Cow's milk (CM) contains more than 40 proteins, including casein (Bos d 8), -lactalbumin (Bos d 4), and -lactoglobulin (Bos d 5), identified as major milk allergens.1 Serum specific IgE (sIgE) to casein characterized patients with persistent CMA,3 CM tolerance,4 and reactivity to baked milk.5
Oral immunotherapy (OIT) for CMA has been used with interesting outcomes as it may induce immunologic tolerance.1,2 However, a safety perspective represents a relevant concern, because reactions to OIT are frequent1,2 It has been demonstrated that sIgE to raw CM >50 kUA/L predicted not-tolerated OIT.6
Molecular-based allergy diagnostics have now become recently available in clinical practice. This method allows for defining and characterizing the sensitization profile that identifies potentially dangerous proteins and suggests a more precise prognosis. In this regard, Cingolani and colleagues reported that component resolved diagnosis had a good ability to define 2 phenotypes of CMA children: "high-anaphylaxis risk" and "milder-risk".7
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