Natural History of Food Allergy - 2018 WSAAI update

This is a Twitter summary from the 2018 WSAAI meeting. This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2018 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.

Robert A. Wood on The Natural History of Food Allergy.

Trends in Cow's Milk IgE over time by resolution status:

So, while IgE is not a perfect predictor of CMA resolution, it is the best predictor.

In CoFAR study about 53% of those with milk allergy resolved by 63 months:

If you had a baseline milk IgE of greater than 10, then you only had about 20% likelihood of cows milk allergy resolution by 72 months:

You can go on to CoFAR website and use online calculator to obtain the likelihood of resolution of cow's milk allergy by first grade -

Allergic (atopic) march (click here to enlarge the image). Allergic (Atopic) March refers to the natural history or typical progression of allergic diseases that often begin early in life. These include atopic dermatitis (eczema), food allergy, allergic rhinitis (hay fever) and asthma.

Egg tolerance also predicted by peak egg-IgE:

Similarly, wheat and soy allergy resolution is also predicted by the IgE level - higher IgE, less likely to outgrow.

Conclusion & clinical implications - cow's milk, egg, wheat & soy allergy:

21.5% of children with a clear diagnosis of peanut allergy were shown to have outgrown their allergy (Skolnick JACI 2001), this still pretty much holds true today.

For patients with persistent peanut allergy, the rates of accidental peanut exposures and severe rxns may be lower than 10-20 years ago (Newman et al @AnnalsAllergy 2012).

While peanut IgE levels cannot be used to predict reaction severity in individual patients, higher levels are overall associated with more severe reactions. (Newman et al @AnnalsAllergy 2012).

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