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Open oral food challenge in the confirmation of cow's milk allergy mediated by immunoglobulin E

Bicudo Mendonça, R.; Motta Franco, J.; Rodrigues Cocco, R.; Suano de Souza, F.I.; Lopes de Oliveira, L.C.; Saccardo Sarni, R.O.; Solé, D.

Published in Allergol Immunopathol (Madr). 2012;40:25-30. - vol.40 núm 01

English: [ Abstract | Full text | PDF ]

Abstract

Background

The most reliable method to diagnose food allergy or to determine tolerance is the oral food challenge.

Objectives

The aim of this study was to describe the open oral food challenge applied to children with suspicion of cow's milk allergy mediated by immunoglobulin E, and evaluate the relation between the clinical history and skin prick test with the challenge outcomes.

Patients and methods

Forty-six children (median age 13.8 months), with clinical history of immediate reactions to cow's milk and positive skin prick test, underwent an open oral food challenge with cow's milk.

Results

The challenge was positive in 41.3%. Cutaneous reactions were the most common (73.7%), followed by respiratory (57.9%) and gastrointestinal reactions (36.8%). According to the severity of the reactions, 57.9%, 36.8% and 5.3% had mild, moderate and severe reactions, respectively. Oral antihistamine was sufficient as treatment in all positive cases. A higher frequency of positive skin prick test with total milk and casein was observed in children with positive oral food challenge. There was a significant agreement between the reactions reported by the family history and those observed during the challenge for 68.4% of children with positive results (Kappa=0.728; p<0.001).

Conclusions

The method was considered suitable for children up to three years of age, and is safe and easy to perform. There was a significant correlation between the clinical history and the challenge outcomes. A positive skin prick test with total milk and casein was significantly associated with positive challenge results.

Key words: Children. Cow's milk allergy. Diagnosis of food allergy. Milk hypersensitivity. Oral food challenge.

Introduction

Introduction Food allergy is defined as an adverse immune response to food proteins. Based on the immunological mechanism involved in the reaction, it may be further classified in: (a) immunoglobulin E (IgE)-mediated; (b) non-IgE-mediated (mostly cell-mediated); (c) mixed.¹^,² The IgE-mediated reactions occur within minutes to 2h after allergen exposure. The symptoms include cutaneous manifestations (urticaria, pruritus, angio-oedema, erythema), gastrointestinal (itching and pruritus of the lips, mouth and tongue, nausea, vomiting, diarrhoea), respiratory (rhinoconjunctivitis, sneezing, wheezing, cough and laryngeal oedema) and systemic syndrome (anaphylaxis with hypotension, respiratory distress and shock).²^,³^,⁴ Cow's milk allergy (CMA) is the most common food allergy in infants, affecting 2–3% of children under one-year of age.⁵^,⁶ CMA is habitually transitory and the majority of children acquire tolerance from the age of three years.⁷^,⁸ The most reliable method to diagnose CMA or to determine tolerance is the oral food challenge (OFC).⁹^,¹⁰ There are three types of OFC: double-blind; placebo controlled (DBPC); single-blind; and open.¹¹ It is reported that only about one-third of suspected food allergies result in a positive challenge.¹² Considering the practical aspects of the open challenge, it may be the first choice when the need for OFC is established, especially in children under three years of age.¹¹^,¹³ Studies evaluating open OFC in an evidence-based manner are extremely rare, and there is no standardised method. The aim of this study was to describe the open OFC applied to children under three years of age with suspicion of IgE-mediated CMA followed in a specialised service. The second goal...

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Bicudo Mendonça, R.^a; Motta Franco, J.^b; Rodrigues Cocco, R.^a; Suano de Souza, F.I.^a; Lopes de Oliveira, L.C.^a; Saccardo Sarni, R.O.^a; Solé, D.^a