SERUM SPECIFIC-IGE ANTIBODIES TO PEPTIDES DETECTED IN A CASEIN HYDROLYSATE FORMULA

Up to 2.5% of infants are affected by cow milk hypersensitivity in the first two years of life, although most of these children will ''outgr ow'' their reactivity within 2-3 years. Extensively hydrolyzed (''hypo allergenic'') cow milk-based formulae are often recommended as a subst itute formula and are generally well tolerated. However, a small minor ity of cow milk-allergic children experience allergic reactions to the hypoallergenic formulae as well. Utilizing inhibition-ELISAs and sera from patients with IgE-mediated cow milk allergy, we have identified residual protein fractions less than 20 kD in several of the extensive ly hydrolyzed cow milk-based formulae. Although many of the cow milk a llergic children had positive skin prick tests [SPT] to one of the hyd rolysate formulae (Nutramigen(TM)), the positive skin test result gene rally did not correlate with clinical reactivity, although the negativ e predictive value of the negative SPT was excellent. Children with Ig E-mediated cow milk allergy and a positive skin prick test to the hypo allergenic formula should probably receive their first dose of the for mula in a medical setting so that appropriate therapy can be administe red in the unlikely event of an allergic reaction.