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Milk Allergen by the Numbers

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Milk Allergen by the Numbers Milk allergen component testing Bos d4 Milk Bos allergen d5 Bos by the d8 numbers Detect sensitizations to the complete milk protein to create personalized management plans for your patients. High levels of milk IgE may predict the likelihood of sensitivity, but may not be solely predictive of TC 2851 reactions to baked milk or α-lactalbumin allergy duration.1 • Susceptible to heat denaturation2 • HIGHER RISK of reaction to fresh milk1,3 • LOWER RISK of reaction Milk allergen to baked milk1,3,a • Patient likely to “outgrow” component testing milk allergy4 Measurement of specific IgE by blood test that provides objective assessment of sensitization to milk is the first step in discovering your patient’s allergy. Milk allergen component tests can help α-lactalbumin β-lactoglobulin Casein Test interpretations and next steps you determine the likelihood of reaction to baked goods, such as cookies or cheese pizza, as well as • Avoid fresh milk the likelihood of allergy persistence. + + - • Likely to tolerate baked milk products • Baked milk oral food challenge (OFC), Knowing which protein your patient is with a specialist may be appropriate sensitized to can help you develop a + - - • Likely to outgrow allergy management plan.3,5-9 - + - • Avoid all forms of milk +/- +/- + • Unlikely to become tolerant of milk over time • Avoid milk and baked milk products (yogurt, cookies, cakes), as well as products processed with milk (chocolate, sausage, potato chips) % of children with milk allergy 75 do not react to baked milk.3 Bos d4 Bos Bos d5 d8 TC 2852 TC 2853 β-lactoglobulin Casein Determine • Susceptible to heat • Resistant to heat which proteins denaturation2 denaturation3 your patient is • HIGHER RISK of reaction • HIGHER RISK of reaction to fresh milk1,3 to all forms of milk1,3,5 sensitized to. • LOWER RISK of reaction • Patient unlikely to outgrow to baked milk1,3,a milk allergy with high levels 4 • Patient likely to outgrow of specific IgE to casein milk allergy4 α-lactalbumin β-lactoglobulin Casein Test interpretations and next steps • Avoid fresh milk + + - • Likely to tolerate baked milk products • Baked milk oral food challenge (OFC), with a specialist may be appropriate + - - • Likely to outgrow allergy - + - • Avoid all forms of milk +/- +/- + • Unlikely to become tolerant of milk over time • Avoid milk and baked milk products (yogurt, cookies, cakes), as well as products processed with milk (chocolate, sausage, potato chips) As in all diagnostic testing, a diagnosis must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgement. a In clinical studies, extensively baked muffin, waffle, and cheese pizza were heated to the point of protein denaturation. Diagnose Evaluate Address Enable by the potential anxiety confidence numbers. reaction to baked with individualized in dietary and milk products. management plans. lifestyle choices. Test Name Test Code Test Name Test Code Food Allergy Profile Childhood Allergy Profile - Egg white, (NTC-2801) f1; Milk, f2; Codfish, - D. pteronyssinus (House mite), (NTC-2721) d1; (NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC- D. farinae (House mite), (NTC-2722) d2; Cat 2808) f8; Sesame seed, (NTC-2810) f10; Peanut, 10715 dander, (NTC-2601) e1; Dog dander, (NTC-2605) (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, e5; Egg white, (NTC-2801) f1; Milk, f2; Codfish, (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, 10659 (NTC-3489) f256; Scallop, (NTC-273) f338 (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, (NTC-3489) Food Allergy Profile w/Reflexes f256; Cockroach, (NTC-2736) i6; Cladosporium - Contains all components of the Food Allergy herbarum, (NTC-2702) m2; Alternaria alternata, Profile (NTC-10715) with reflex to the following (NTC-2706) m6; Total IgE components, with reflex to Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) Childhood Allergy Profile w/Reflexes f233; Ovalbumin, (NTC-2719) f232; Milk 91682 - D. pteronyssinus (House mite), (NTC-2721) d1; Component Panel, (NTC-91403); Casein, f78; D. farinae (House mite), (NTC-2722) d2; Cat Alpha-lactalbumin, f76; Beta-lactoglobulin, f77; dander, (NTC-2601) e1; Dog dander, (NTC-2605) Peanut Component Panel, (NTC-91681) Ara h1, e5; Egg white, (NTC-2801) f1; Milk, f2; Codfish, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, 91683 h9 (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, (NTC-3489) Milk Component Panel f256; Cockroach, (NTC-2736) i6; Cladosporium - Casein, f78; Alpha-lactalbumin, f76; 91403 herbarum, (NTC-2702) m2; Alternaria alternata, Beta-lactoglobulin, f77 (NTC-2706) m6; Total IgE Alpha-lactalbumin 2851 Food Allergy Panel - Milk, f2; IgE Egg white, (NTC-2801) f1; IgE Peanut, Beta-lactoglobulin 2852 (NTC-2813) f13; IgE Walnut, (NTC-3489) f256; IgE Corn, (NTC-2808) f8; IgE Wheat, (NTC-2804) f4; 38767 Casein 2853 IgE Soybean, (NTC-2814) f14; IgE Codfish, (NTC- 2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, Milk 2802 (NTC-2824) f24; Total IgE Multiple test codes are available. Refer to the Quest Diagnostics Directory of Services or the online Test Center (QuestDiagnostics.com/testcenter) for test information. NTC = National test code For more information about milk component testing, contact your local sales representative. References 1. Shek LP, Bardina L, Castro R, Sampson HA, Beyer K. Humoral and cellular responses to cow milk proteins in patients with milk-induced, IgE-mediated and non-IgE-mediated disorders. Allergy. 2005;60(7):912-919. 2. Wal JM. Bovine milk allergenicity. Ann Allergy Asthma Immunol. 2004;93(5 Suppl 3):S2-S11. 3. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol. 2008;122(2):342-347. 4. Sicherer SH, Sampson HA. Cow’s milk protein-specific IgE concentrations in two age groups of milk-allergic children and in children achieving clinical tolerance. Clin Exp Allergy. 1999;29(4):507-512. 5. Boyano-Martínez T, García-Ara C, Pedrosa M, Díaz-Pena JM, Quirce S. Accidental allergic reactions in children allergic to cow’s milk proteins. J Allergy Clin Immunol. 2009;123(4):883-888. 6. Caubet J, Nowak-Węgrzyn A, Moshier E, Godbold J, Wang J, Sampson HA. Utility of casein-specific IgE levels in predicting reactivity to baked milk. J Allergy Clin Immunol. 2013;131(1):222- 224. 7. CM Allergy Review. Diagnosis of cow’s milk allergy in children: determining the gold standard? Expert Rev Clin Immunol. 2014;10(2):257-267. 8. Kim JS, Nowak-Węgrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011;128(1):125-131. 9. Ito K, Futamara M, Moverare R, et al. The usefulness of casein-specific IgE and IgG4 antibodies in cow’s milk allergic children. Clinical and Molecular Allergy. 2012;10:1:1-7. QuestDiagnostics.com Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2017 Quest Diagnostics Incorporated. All rights reserved. SB5995 05/2017.
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