{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:36:03Z","timestamp":1776677763045,"version":"3.51.2"},"reference-count":19,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T00:00:00Z","timestamp":1776556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Approximately 1\u20132% of infants have cow\u2019s milk protein allergy (CMPA). From a clinical perspective, diagnosing CMPA using the oral food challenge (OFC) is high risk, necessitating safer alternatives. One possible alternative is component-resolved diagnostics (CRD). This narrative review examines specific IgE (sIgE) thresholds for cow\u2019s milk protein in predicting outcomes of OFCs in European children. Eligible studies focusing on CRD in European pediatric populations were identified through PubMed and Scopus databases. Our findings highlight the crucial role of Bos d 8 (casein) in the diagnostic process. Among the analyzed milk components, Bos d 8 appeared to be a promising marker for predicting positive OFC outcomes in several cohorts. However, due to significant population heterogeneity, conflicting findings exist, with some studies indicating that no single molecular component is consistently superior to whole cow\u2019s milk specific IgE. While other molecules, such as Bos d 6 and lactoferrin, showed limited diagnostic utility, specific IgE to Bos d 8 demonstrated the highest clinical value. Although the double-blind, placebo-controlled food challenge (DBPCFC) remains the gold standard for CMPA diagnosis, the use of Bos d 8 in CRD is a key step toward risk stratification and may help reduce the need for high-risk OFCs in selected patients.<\/jats:p>","DOI":"10.3390\/ijms27083643","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T08:24:23Z","timestamp":1776673463000},"page":"3643","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting Oral Food Challenge Outcomes in Cow\u2019s Milk Protein Allergy: The Crucial Role of Bos d 8 and Component-Resolved Diagnostics: A Narrative Review"],"prefix":"10.3390","volume":"27","author":[{"given":"Weronika","family":"Balas","sequence":"first","affiliation":[{"name":"Clinical Department of Paediatrics and Allergology, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandra","family":"Tylewicz","sequence":"additional","affiliation":[{"name":"Clinical Department of Paediatrics and Allergology, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5890-8159","authenticated-orcid":false,"given":"Weronika","family":"Gromek","sequence":"additional","affiliation":[{"name":"Polish-Ukrainian Foundation of Medicine Development, Na\u0142\u0119czowska 14, 20-701 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weronika","family":"Sobota","sequence":"additional","affiliation":[{"name":"Clinical Department of Paediatrics and Allergology, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2389-277X","authenticated-orcid":false,"given":"Adam","family":"Sybilski","sequence":"additional","affiliation":[{"name":"Clinical Department of Paediatrics and Allergology, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland"},{"name":"Department of Paediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3638-9292","authenticated-orcid":false,"given":"Emilia","family":"Majsiak","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Faculty Health of Sciences, Medical University of Lublin, Staszica 4\/6, 20-081 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,19]]},"reference":[{"key":"ref_1","first-page":"675","article-title":"Diagnosis and management of cow\u2019s milk protein allergy: A position paper of the Food Allergy Section of the Polish Society for pediatric Gastroenterology, Hepatology and Nutrition","volume":"18","author":"Horvath","year":"2021","journal-title":"Stand. Med. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/apt.12984","article-title":"Review article: The diagnosis and management of food allergy and food intolerances","volume":"41","author":"Turnbull","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_3","unstructured":"Sybilski, A.J. (2021). Algorytmy Post\u0119powania W Alergologii Dzieci\u0119cej, Medical Tribune Poland."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jaip.2019.09.029","article-title":"Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report","volume":"8","author":"Bird","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e13854","DOI":"10.1111\/pai.13854","article-title":"EAACI Molecular Allergology User\u2019s Guide 2.0","volume":"34","author":"Dramburg","year":"2023","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cronin, C., Mu\u00f1oz Archidona, C., Fern\u00e1ndez Prudencio, B., Gallagher, A., Velasco Zuniga, R., and Trujillo Wurttele, J. (2023). Real-Life Use of Component-Specific IgE in IgE-Mediated Cow\u2019s Milk Protein Allergy in a Spanish Pediatric Allergy Centre. Antibodies, 12.","DOI":"10.3390\/antib12040076"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1067\/mai.2001.111592","article-title":"Specific IgE levels in the diagnosis of immediate hypersensitivity to cows\u2019 milk protein in the infant","volume":"107","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1067\/mai.2001.114708","article-title":"Utility of food-specific IgE concentrations in predicting symptomatic food allergy","volume":"107","author":"Sampson","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Knyziak-M\u0119drzycka, I., Majsiak, E., and Cukrowska, B. (2023). Allergic March in Children: The Significance of Precision Allergy Molecular Diagnosis (PAMD@) in Predicting Atopy Development and Planning Allergen-Specific Immunotherapy. Nutrients, 15.","DOI":"10.3390\/nu15040978"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/pai.12854","article-title":"Cow\u2019s milk allergic children-Can component-resolved diagnostics predict duration and severity?","volume":"29","author":"Petersen","year":"2018","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1111\/j.1398-9995.2008.01748.x","article-title":"Clinical usefulness of microarray-based IgE detection in children with suspected food allergy","volume":"63","author":"Ott","year":"2008","journal-title":"Allergy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0301-0546(08)75864-6","article-title":"The predictive value of specific immunoglobulin E levels in serum for the outcome of the development of tolerance in cow\u2019s milk allergy","volume":"36","author":"Martorell","year":"2008","journal-title":"Allergol. Immunopathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1111\/j.1365-2222.2010.03568.x","article-title":"Performance of a component-based allergen-microarray in the diagnosis of cow\u2019s milk and hen\u2019s egg allergy","volume":"40","author":"Pellegrino","year":"2010","journal-title":"Clin. Exp. Allergy"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Alessandri, C., Sforza, S., Palazzo, P., Lambertini, F., Paolella, S., Zennaro, D., Rafaiani, C., Ferrara, R., Bernardi, M.L., and Santoro, M. (2012). Tolerability of a fully maturated cheese in cow\u2019s milk allergic children: Biochemical, immunochemical, and clinical aspects. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0040945"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.aller.2020.03.007","article-title":"Predictors of a positive oral food challenge to cow\u2019s milk in children sensitized to cow\u2019s milk","volume":"48","year":"2020","journal-title":"Allergol. Immunopathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.23822\/EurAnnACI.1764-1489.123","article-title":"Blood or skin: What is best in predicting cow\u2019s milk allergy diagnosis?","volume":"52","author":"Romeira","year":"2020","journal-title":"Eur. Ann. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.2500\/aap.2023.44.220079","article-title":"Molecular allergy diagnostics in predicting oral cow\u2019s milk challenge outcome in Finnish children","volume":"44","author":"Nieminen","year":"2023","journal-title":"Allergy Asthma Proc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1129449","DOI":"10.1155\/2023\/1129449","article-title":"Molecular Allergy Diagnostics in Children with Cow\u2019s Milk Allergy: Prediction of Oral Food Challenge Response in Clinical Practice","volume":"2023","author":"Tosca","year":"2023","journal-title":"J. Immunol. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.2147\/JAA.S372928","article-title":"The Precision Allergy Molecular Diagnosis (PAMD@) in Monitoring the Atopic March in a Child with a Primary Food Allergy: Case Report","volume":"15","author":"Szychta","year":"2022","journal-title":"J. Asthma Allergy"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3643\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T08:36:17Z","timestamp":1776674177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,19]]},"references-count":19,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijms27083643"],"URL":"https:\/\/doi.org\/10.3390\/ijms27083643","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,19]]}}}