Milk allergen component testing

Detect sensitizations to the complete milk protein to create personalized management plans for your patients.

Milk allergen by the numbers

Bos

d4

Bos

d5

Bos

d8

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)

Milk allergen component testing 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 you determine the likelihood of reaction to baked goods, such as cookies or cheese pizza, as well as the likelihood of allergy persistence.

High levels of milk IgE may predict the likelihood of sensitivity, but may not be solely predictive of reactions to baked milk or allergy duration.1

• Susceptible to heat denaturation2

• HIGHER RISK of reaction to fresh milk1,3

• LOWER RISK of reaction to baked milk1,3,a

• Patient likely to “outgrow” milk allergy4

Knowing which protein your patient is sensitized to can help you develop a management plan.3,5-9

TC 2851 α-lactalbumin

75% of children with milk allergy do not react to baked milk.3

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.

• Susceptible to heat denaturation2

• HIGHER RISK of reaction to fresh milk1,3

• LOWER RISK of reaction to baked milk1,3,a

• Patient likely to outgrow milk allergy4

• Resistant to heat denaturation3

• HIGHER RISK of reaction to all forms of milk1,3,5

• Patient unlikely to outgrow milk allergy with high levels of specific IgE to casein4

Determine which proteins your patient is sensitized to.

TC 2853 Casein

TC 2852 β-lactoglobulin

a In clinical studies, extensively baked muffin, waffle, and cheese pizza were heated to the point of protein denaturation.

Bos

d4Bos

d5Bos

d8

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.

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For more information about milk component testing, contact your local sales representative.

Test Name Test CodeChildhood Allergy Profile - D. pteronyssinus (House mite), (NTC-2721) d1;

D. farinae (House mite), (NTC-2722) d2; Cat dander, (NTC-2601) e1; Dog dander, (NTC-2605) e5; Egg white, (NTC-2801) f1; Milk, f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, (NTC-3489) f256; Cockroach, (NTC-2736) i6; Cladosporium herbarum, (NTC-2702) m2; Alternaria alternata, (NTC-2706) m6; Total IgE

10659

Childhood Allergy Profile w/Reflexes - D. pteronyssinus (House mite), (NTC-2721) d1;

D. farinae (House mite), (NTC-2722) d2; Cat dander, (NTC-2601) e1; Dog dander, (NTC-2605) e5; Egg white, (NTC-2801) f1; Milk, f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, (NTC-3489) f256; Cockroach, (NTC-2736) i6; Cladosporium herbarum, (NTC-2702) m2; Alternaria alternata, (NTC-2706) m6; Total IgE

91683

Food Allergy Panel - Milk, f2; IgE Egg white, (NTC-2801) f1; IgE Peanut,

(NTC-2813) f13; IgE Walnut, (NTC-3489) f256; IgE Corn, (NTC-2808) f8; IgE Wheat, (NTC-2804) f4; IgE Soybean, (NTC-2814) f14; IgE Codfish, (NTC-2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, (NTC-2824) f24; Total IgE

38767

Diagnoseby the numbers.

Evaluate potential reaction to baked milk products.

Address anxiety with individualized management plans.

Enable confidence in dietary and lifestyle choices.

Test Name Test CodeFood Allergy Profile - Egg white, (NTC-2801) f1; Milk, f2; Codfish,

(NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC-2808) f8; Sesame seed, (NTC-2810) f10; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, (NTC-3489) f256; Scallop, (NTC-273) f338

10715

Food Allergy Profile w/Reflexes - Contains all components of the Food Allergy

Profile (NTC-10715) with reflex to the following components, with reflex to Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, (NTC-2719) f232; Milk Component Panel, (NTC-91403); Casein, f78; Alpha-lactalbumin, f76; Beta-lactoglobulin, f77; Peanut Component Panel, (NTC-91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9

91682

Milk Component Panel - Casein, f78; Alpha-lactalbumin, f76;

Beta-lactoglobulin, f7791403

Alpha-lactalbumin 2851

Beta-lactoglobulin 2852

Casein 2853

Milk2802

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