PMID- 22624437
OWN - NLM
STAT- MEDLINE
DCOM- 20120614
LR  - 20220408
IS  - 1565-1088 (Print)
VI  - 14
IP  - 1
DP  - 2012 Jan
TI  - A new model for conservative food challenge in children with immunoglobulin 
      E-mediated cow's milk allergy.
PG  - 18-23
AB  - BACKGROUND: The diagnostic gold standard for food allergy is an oral food 
      challenge (OFC) with the suspected food. Usually, an OFC is stopped at the onset 
      of mild objective symptoms for fear of severe reactions, but there is no 
      consensus on this issue. OBJECTIVES: To investigate the effectiveness and side 
      effects of a new model of oral milk challenge in order to increase the diagnostic 
      accuracy of cow's milk protein allergy and reduce the number of useless 
      elimination diets. This model is characterized by a conservative diagnostic 
      protocol and "step-up cow's milk dosing." The secondary aim was to investigate 
      possible factors influencing severe reactions. METHODS: Sixty-six children 
      (median age 1 year, range 1-18) with suspected immunoglobulin E (IgE)-mediated 
      cow's milk allergy performed a conservative OFC, i.e., the OFC was continued even 
      in the presence of subjective, even repeated, or mild local or multiple organ 
      objective symptoms. If the first objective reaction occurred when the quantity of 
      milk was > 10 ml, the investigator would decide whether to continue the OFC or 
      prescribe a gradual increase in milk feeding at home. RESULTS: Symptoms developed 
      during the OFC in 42.4% of the children. Local, generalized and severe 
      generalized reactions developed in 11 (16.7%), 11 (16.7%) and 6 (9.1%) children, 
      respectively. Only 14/28 (50%) who developed objective symptoms during the OFC 
      were considered to be affected by cow's milk allergy. In the remaining 14 both 
      subjective and objective symptoms developed and the OFC was continued without 
      further symptoms. Epinephrine was administered to 6 of the 28 children (21.4%) 
      who developed objective symptoms. All but one had subjective symptoms following 
      the early doses of milk, whereas all children who later tolerated milk had their 
      first subjective or mild symptoms following doses > or = 10 ml. CONCLUSIONS: This 
      new model of OFC criteria led to frequent severe allergic reactions; hence its 
      use in daily practice seems inadvisable. However, our study provides evidence 
      that a severe allergic reaction does not invariably occur if, the offending food 
      continues to be administered after the onset of symptoms. If mild symptoms appear 
      at doses > 10 ml, continued milk administration, on the same day or in subsequent 
      days, seems to facilitate the development of tolerance and may reduce the number 
      of useless elimination diets.
FAU - Calvani, Mauro
AU  - Calvani M
AD  - Department of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy. 
      MI5660@mclink.it
FAU - Iacono, Iride Dello
AU  - Iacono ID
FAU - Giorgio, Valentina
AU  - Giorgio V
FAU - Sopo, Stefano Miceli
AU  - Sopo SM
FAU - Panetta, Valentina
AU  - Panetta V
FAU - Tripodi, Salvatore
AU  - Tripodi S
LA  - eng
PT  - Journal Article
PL  - Israel
TA  - Isr Med Assoc J
JT  - The Israel Medical Association journal : IMAJ
JID - 100930740
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Immunoglobulin E/*immunology
MH  - Infant
MH  - Male
MH  - Milk Hypersensitivity/*diagnosis/immunology
MH  - Prospective Studies
MH  - Skin Tests
EDAT- 2012/05/26 06:00
MHDA- 2012/06/15 06:00
CRDT- 2012/05/26 06:00
PHST- 2012/05/26 06:00 [entrez]
PHST- 2012/05/26 06:00 [pubmed]
PHST- 2012/06/15 06:00 [medline]
PST - ppublish
SO  - Isr Med Assoc J. 2012 Jan;14(1):18-23.