Usefulness of casein specific IgE and IgG antibodies to immediate type cow's milk allergy

PURPOSE: Cow's milk-specific IgE (CM-IgE) has been proposed as one of the valuable markers for diagnosis of clinical cow's milk (CM) allergy. In this study, we evaluated the additional usefulness of casein-specific IgE (casein-IgE) and IgG (casein-IgG) for the diagnosis of clinical CM allergy. METHODS: Fifty-eight subjects, aged from 3 months to 154 months, were enrolled. Thirty-four patients showed immediate-type of clinical CM allergy, and 24 patients were atopic controls. The serum levels of CM-IgE, casein-IgE, and casein-IgG were measured. Patients were divided into 2 groups: those aged under 12 months and those aged 12 months or over. The diagnostic values of each antibody were analyzed and compared using the Mann-Whitney U-test and receiver operating characteristic curves. RESULTS: CM allergy had significantly higher levels of CM-IgE and casein-IgE, and lower levels of casein-IgG/IgE ratio when compared to atopic controls in both age groups (P<0.05). CM-IgE and casein-IgE were shown to be better predictive markers for immediate-type CM allergy in patients under 12 months, while casein-IgG/IgE ratio was a more useful marker in those aged 12 months or over. Considering 100% positive predictive values, cutoff points were 1.04 kU/L for CM-IgE, 0.11 kU/L for casein-IgE, 19.5 for casein-IgG/IgE ratio in patients aged under 12 months, and 7.1 kU/L for CM-IgE, 1.41 kU/L for casein-IgE, 12.51 for casein-IgG/IgE ratio in those aged 12 months or over. CONCLUSION: CM-IgE, casein-IgE, and casein-IgG/IgE ratio are useful markers for predicting immediate-type CM allergy. Further studies are needed on diagnostic decision points for CM allergy using combination of cutoff values of these 3 markers.

Various Renal Manifestations in Children with Tuberous Sclerosis Complex

Tuberous sclerosis complex (TSC) is a genetic disorder that affects multiple organ systems and causes tumors. It is important that physicians are aware of the manifestations of TSC, and that they follow the recommendations for screening and evaluation. Several types of renal abnormalities may develop in individuals with TSC. Individuals with TSC may require ongoing treatment that can be adapted for each arising manifestation of renal disease. Herein, we report 4 patients with TSC who presented with a range of different renal manifestations, including angiomyolipoma, renal cell carcinoma, renal infarction, renal cyst, and nephrolithiasis.