Cow's milk allergy: Laboratory diagnostic tools

Allergy to cow's milk (CM) is one of the three most frequent allergies in childhood (Alduraywish et al., 2016). Various mechanisms may be involved: either IgE-mediated or cellular mechanisms, with immediate or delayed symptoms. Furthermore, CM allergy has different phenotypes: although most CM allergic children become tolerant when they grow up and can tolerate milk after prolonged boiling, others develop a persistent allergy and react after ingestion of traces of milk, however much it is boiled. CM can cause very severe clinical symptoms and it is therefore important to have validated laboratory diagnostic tools available to confirm an allergy to CM, to identify the mechanisms involved, and to evaluate the patient's "allergic profile". Numerous studies have shown that definition of the sensitization profile of CM allergic patients based on the study of specific IgE directed against CM and its different fractions can provide useful and non-invasive assistance with the IgE-mediated forms of CM allergy. In the future, new laboratory tools such as cellular tests will probably provide additional information, particularly regarding the non-IgE mediated forms. (C) 2017 Elsevier Masson SAS. All rights reserved.