scholarly journals Algorithm of conducting oral provocation tests with milk in 1–3-year-old children: analysis of existing standards and own experience

Introduction. Food allergy is an urgent problem in modern pediatrics. Cow’s milk is the main food allergen in young children. By the age of one year, from 0.5 % to 3 % of children suffer from cow’s milk protein allergy. Aim. To analyze the existing standards of conducting oral provocation tests with milk in young children and suggest own algorithm of diagnostics. Materials and methods. Algorithm of diagnosing cow’s milk allergy was probated in 107 children aged from one to three years in Communal Municipal Children’s Clinical Hospital. To diagnose cow’s milk allergy, compilation of allergological anamnesis, examination, assessment of physical development, and determination of specific IgE to cow’s milk are performed. Then, different oral provocation tests are conducted based on the obtained results: at the allergist’s office on an outpatient basis, in a specialized inpatient department, in an intensive care unit. Results. Among 107 children, who were subjected to oral provocation test with milk, cow’s milk protein allergy was diagnosed in 67 (62.62 %). In children, who were diagnosed cow’s milk protein allergy (n = 67), skin (41.79 %) and gastrointestinal (28.36 %) symptoms prevailed. In the group of children with predictable low risk of allergy, diameter of a papule equaled 3.86 ± 0.62 mm2, the level of specific IgE to milk in blood serum was 0.58 [0.37–0.68], and in the group with medium risk – 5.51 ± 1.38 mm2 and 3.62 [0.86–9.66] kU/L, respectively. All 40 children, in whom cow’s milk protein allergy was not confirmed, constituted the group with predictable low risk of reaction development. Diameter of a papule during prick-test equaled 3.13 ± 0.24 mm2, the level of specific IgE to milk in blood serum was 0.36 [0.35–0.67] kU/L. In this group of children, complaints of gastrointestinal symptoms (82.5 %) prevailed. Conclusions. A complex diagnostic approach, in particular, study of anamnesis, examination, assessment of physical development, record of food diary, determination of specific IgE to milk, oral provocation tests enable to optimize diagnostics of food allergy and choose further therapeutic tactics. Algorithm of diagnosing cow’s milk protein allergy in 1–3-year-old children has been elaborated, which can be recommended for common application in clinical practice.

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 938-939
Author(s):  
BRUCE TAUBMAN

In the article by Drs Lothe and Lindberg, they purport to examine the relationship between infant colic and cow's milk protein allergy. However, the majority of the infants they studied did not fit the definition of infants with colic. The authors claimed the definition they used for their study corresponded to that of Wessels et al, Carey, and Schmitt. Yet, each of these physicians defined the syndrome of infant colic as excessive crying in "otherwise healthy" infants.


Author(s):  
Maria do Carmo Andrade Duarte de Farias ◽  
Loianne Pereira Araruna ◽  
Daniel Fonsêca de Miranda ◽  
Bárbara Carvalho Dantas ◽  
Eliane de Sousa Leite ◽  
...  

2015 ◽  
Vol 12 (1) ◽  
pp. 73-78
Author(s):  
I V Vorozhko ◽  
T B Sentsova ◽  
V A Revyakina ◽  
O O Chernyak ◽  
S N Denisova

Immunological estimating of different diet therapy types became currently very important. The aim of this work was to study the changes of immunological biomarkers during usage of formulas based on different sources of protein in children with food allergy and to assess and predict the effectiveness of diet therapy. The study included 66 children with food allergy in age from 1,5 months to 1,5 years. Observed children were divided into three groups depending on the type of formulas used. The dynamics of immunoregulatory substances (IL-5, TGF β 1, IL-10, IL-4, IL-2, IL-13, Eotaxin3), and allergenspecific IgE and IgG antibodies to cow’s milk protein, α-lactoglobulin, β-laktoglobulin, casein, soy and goat’s milk during diet therapy were evaluated. Observation duration was 28-30 days. The differences in the dynamics of the investigated parameters depending on the type of formula were revealed. Thus, the use of formula based on cow’s milk hydrolysates revealed their primarily effect on cytokines IL-2, IL-5 and growth factor TGF β ; the use of formula based on soy protein revealed combined effect on humoral immunity (allergen specific IgE and IgG antibodies) and IL-5; the use of formula based on goat milk characterized decreased levels of allergenspecific IgG antibodies to the cow’s milk protein and its fractions, reduced allergen specific IgE antibody concentrations to cow’s milk protein and α-lactoglobulin, decreased levels of IL-5, and, exclusive for this formula - reduction of IL-4 level. Accordingly, the assessment of immunological biomarkers can be used to personalize diet therapy in children with food allergy.


1987 ◽  
Vol 22 (1) ◽  
pp. 99-99 ◽  
Author(s):  
E Savilahti ◽  
L Salmenperä ◽  
V -M Tainio ◽  
P Arjomaa ◽  
M A Siimes ◽  
...  

Author(s):  
Oksana Matsyura ◽  
◽  
Lesya Besh ◽  
Natalia Lukyanenko ◽  
Oksana Kovalska ◽  
...  

Background. Cow's milk protein allergy is a topical issue in pediatrics. This disease affects 2-3% of young children. Methods. The study included 30 children with a confirmed cow’s milk protein allergy and a prescribed milk elimination diet. The children were observed for 36 months. The molecular profile was evaluated by detecting the major components of milk (Bos d 8, Bos d 5, Bos d 4), minor (Bos d 6), and cross-reactive with serum albumin (Fel d 2, Can f 3). Results. The study group included 46.7% of boys. The mean age of the subjects was 14.5±3.18 months. Nine of the 25 analyzed factors were identified in the course of our work by the method of logistic regression with progressive selection, which in combined action affect the formation of tolerance to cow's milk proteins in allergic children. There are three clinical examples of calculating the prediction of the complete tolerance development in the elimination diet in children with cow's milk protein allergy. Conclusions. Independent predictors that reduce the likelihood of the tolerance development in the elimination diet, have identified: skin test to milk, Bos d 8, Bos d 5, Bos d 4, Bos d 6. Independent predictors of the tolerance development in the elimination diet are: milk-specific IgE, total IgE, Fel d 2, Can f 3. Low probability of tolerance development by elimination therapy is a recommendation for prescribing treatment to a patient by specific oral tolerance induction.


2013 ◽  
Vol 10 (2) ◽  
pp. 61-65
Author(s):  
E E Varlamov ◽  
T S Okuneva ◽  
A N Pampura

Introduction. The main principle of treatment of cow’s milk allergy (CMA) is the elimination from the diet of cow’s milk. However recently has been discussing the possibility to substitute the cow’s milk with goat’s milk in children with allergy to cow s milk protein. Background. To determine the relationship between sensitization to cow’s milk specific allergens in goat’s milk sensitized children. Methods. The study included 88 children with suspected allergy to CMA. All patients underwent determination of specific IgE to allergen of cow’s and goat’s milk allergen (ImmunoCAP 100 Phadia AB). We identified 35 children with sensitization to cow’s milk and measured specific IgE to α-laktalbumin, β-lactoglobulin and casein. Results. Sensitization to goat’s milk was estimated in 83% of patients with sensitization to cow’s milk. There was a significant positive correlation between the concentration of specific IgE to goat’s milk allergen and specific IgE to the cow’s milk allergen (R=0,91, p=0,0000001), a-laktalbumin (R=0,76, p=0,000007), β-lactoglobulin (R=0,72, p=0,000038) and casein (R=0,91, p=0,0000001). Conclusion. Formulas based on goat milk can not be considered hypoallergenic for children allergic to cow’s milk. Crosssensitization is mediated mainly with sensitization to casein. Introduction of goat milk and its derivatives in the diet of a child with an allergy to cow’s milk can be proven only by the absence of clinically relevant sensitization to goat milk.


Sign in / Sign up

Export Citation Format

Share Document