Background: Cow's milk is one of the most common causes of food allergy in the first years of life. We recently defined IgE-binding epitopes of all 6 major cow's milk proteins (αs1-, αs2-, β-, and κ-casein; α-lactalbumin; and β-lactoglobulin) and had some evidence suggesting that IgE antibodies from patients with persistent cow's milk allergy (CMA) recognize different epitopes on cow's milk proteins than do those from patients who were likely to outgrow their allergy. Objective: In this study we sought to assess whether recognition of IgE antibodies of certain epitopes of cow's milk proteins would clearly separate the patients with life-long CMA from those who will become clinically tolerant to cow's milk. Methods: According to the known IgE-binding regions of cow's milk proteins, 25 decapeptides of αs1-casein, αs1-casein, κ-casein, κ-lactalbumin, and β-lactoglobulin, comprising the core epitopes, were synthesized on a cellulose-derivatized membrane. Sera from 10 patients with persistent CMA and 10 patients who subsequently outgrew their milk allergy were used to investigate the differences in epitope recognition. Results: Five IgE-binding epitopes (2 on αs1-casein, 1 αs1-casein, and 2 on κ-casein) were not recognized by any of the patients with transient CMA but showed binding by the majority of the patients with persistent allergy. The presence of IgE antibodies against at least 1 of 3 epitopes (amino acid [AA] 123-132 on αs1-casein, AA 171-180 on αs2-casein, and AA 155-164 on κ-casein) identified all patients with persistent CMA. Conclusions: The presence of IgE antibodies to distinct allergenic epitopes of cow's milk proteins can be used as a marker of persistent CMA. Prospective studies are needed to investigate the usefulness of these informative epitopes in predicting life-long CMA in young children.

Original languageEnglish
Pages (from-to)293-297
Number of pages5
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - Aug 2002


  • B-cell epitope
  • Caseins
  • Children
  • Cow's milk allergy
  • Cow's milk proteins
  • Cow's milk-specific IgE
  • Natural history
  • Oral tolerance
  • α-lactalbumin
  • β-lactoglobulin


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