Clinical predictors of persistence in IgE-mediated cow’s milk allergy in children with multiple food allergies

Abstract Objective This study aimed to identify independent clinical predictors of failure to develop tolerance to IgE-mediated cow’s milk allergy in children with multiple food allergies. Method This retrospective cohort study included 134 children diagnosed with IgE-mediated cow’s milk allergy with multiple food allergies. Patients were divided into two groups based on tolerance development: those who developed tolerance and those who did not. Demographic characteristics, clinical findings after food intake, and laboratory parameters were compared between groups. To identify independent clinical risk factors associated with the lack of tolerance development, clinical variables found to be statistically significant ( p < 0.05) in univariate analyses were included in multivariate logistic regression analysis. Results Ninety-six patients (71.6%) were male, with a median age of 84 months (range: 33–146 months). The median age at symptom onset was 5 months (range: 1–36 months), and the median follow-up duration was 79 months (range: 1–93 months). Atopic eczema was present in 42.5% of patients, and a history of recurrent wheezing or asthma was present in 14.2%. Among concomitant food allergies, egg allergy was the most common (50.7%). While cutaneous findings were most frequently observed in initial reactions, wheezing (18.7%) was the most common respiratory symptom. Anaphylaxis was diagnosed in 24.6% of patients. In the multivariate logistic regression analysis performed to determine the clinical risk factors associated with the failure to develop tolerance to IgE-mediated cow’s milk allergy in patients, the following factors were identified: as the initial reaction after cow’s milk intake are anaphylaxis OR: 4.95 (1.82–13.5), p = 0.002, hypotension OR: 3.97 (1.19–13.2), p = 0.025), wheezing OR: 2.86 (1.11–7.36), p = 0.029 and lethargy OR: 3.53 (1.23–10.1), p = 0.019) were identified as independent risk factors. Conclusion Severe clinical reactions initially presenting with systemic and respiratory involvement are independent clinical predictors of failure to develop tolerance to IgE-mediated cow’s milk allergy in children with multiple food allergies.