IgE sensitisation to cow’s milk proteins among children with suspected cow’s milk allergy: A retrospective study in Abidjan

Introduction: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. In low- and middle-income countries, limited access to oral food challenges makes the skin prick test (SPT) a practical alternative for identifying IgE-mediated forms. Aim: To determine the prevalence of IgE sensitisation to cow's milk proteins among children referred for suspected CMPA and to identify associated clinical factors. Methods: A retrospective analytical study was conducted from January 2021 to December 2024 in the Immunoallergology Unit of the University Hospital of Cocody, Abidjan, Côte d'Ivoire. Children aged 0-36 months underwent SPT using a commercial extract or a prick-to-prick technique with pasteurised/UHT milk. A wheal ≥3 mm above the negative control defined positivity. Clinical data included age, feeding mode, family atopy, and symptoms type. Cutaneous manifestations were analysed as a composite variable due to inconsistent distinction between eczema and urticaria. Proportions were expressed with 95% confidence intervals (Wilson method), and group comparisons used chi-square or Fisher's exact tests (p < 0.05). Results: Two hundred children were included (mean age 17.8 months; 55.5% boys). Overall, 29.5% (59/200; 95% CI 23.6-36.2) had a positive SPT. Sensitisation was higher in infants <12 months (38.1% vs 23.3%, p = 0.021), in those with eczema (37.8% vs 17.3%, p < 0.001), and in those with a family history of atopy (32.0% vs 9.1%, p = 0.039). Digestive symptoms were inversely associated with sensitisation (14.9% vs 36.8%, p = 0.001). No cases of anaphylaxis were documented. Conclusion: Nearly one-third of children referred for suspected CMPA showed IgE sensitisation. In resource-limited settings, the SPT remains a useful triage tool, particularly in infants with eczema or family atopy, whereas isolated digestive symptoms are less predictive. Interpretation should consider the retrospective design and the absence of confirmatory oral food challenges.