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.
Shadrin OH, Niankovskyi SL, Umanets TR ta in. Osoblyvosti diahnostyky ta pidkhody do likuvalno-profilaktychnoho kharchuvannia ditei rannoho viku z alerhiieiu do bilka koroviachoho moloka: metod. rekomend. K. TOV «Liudy v bilomu». 2014: 28 s. [In Ukrainian].
Makarova SH, Namazova-Baranova LS, Vyshneva EA y dr. Aktualnыe voprosы dyahnostyky pyshchevoi allerhyy v pedyatrycheskoi praktyke. Vestn. RAMN. 2015; 1: 41–46. [In Russian].
Kaczmarski M., Korotkiewicz-Kaczmarska E. Alergia i nietolerancja pokarmowa – mleko i inne pokarmy. Help-Med S.C. 2015: 164–185.
Muraro A. et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014; 69 (5): 590–601. https://doi.org/10.1111/all
Wauters L, Brown T, Venter C et al. Cow’s milk allergy prescribing is infl uenced by Regional and National Guidance. J Pediatr Gastroenterol Nutr. 2016; 62 (5): 765–770. https://doi.org/10.1097/MPG.0000000000001052
James M John, Burks Wesley, Eigenmann Philippe. Food allergy. Elsevier Inc. 2012; 113–127, 143–204.
Maslin K, Dean T, Arshad SH et al. Fussy eating and feeding difficulties in infants and toddlers consuming a cows’ milk exclusion diet. Pediatr Allergy Immunol. 2015; 26 (6): 503–508. https://doi.org/10.1111/pai.12327
Salvilla SA, Dubois AE, Flokstra-de Blok BM et al. Disease-specific health-related quality of life instruments for IgE-mediated food allergy. Allergy. 2014; 69: 834–844.
Yamamoto-Hanada K, Futamura M, Takahashi O et al. Caregivers of children with no food allergy-their experiences and perception of food allergy. Pediatr Allergy Immunol. 2015; 26: 614–617.
Saleh-Langenberg J, Goossens NJ, Flokstra-de Blok BM et al. Predictors of health-related quality of life of European food allergic patients. Allergy. 2015; 70: 616–264.
The European Academy of Allergy and Clinical Immunology is in the process of developing the EAACI Guidelines for Allergen Immunotherapy for IgE-mediated food allergy. Clinical and Translational Allergy. 2016; 6: 24. https://doi.org/10.1186/s13601-016-0113-z
Pakholchuk OP. Osoblyvosti veryfikatsii klinichnykh shkirnykh proiaviv kharchovoi alerhii u ditei. Visnyk problem biolohii i medytsyny. 2015; 2 (3): 212–215. [In Ukrainian].
Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy. Medykamentozna alerhiia, vkliuchaiuchy anafilaksiiu (№ 916 vid 30.12.2015 r.). [In Ukrainian]. Dostupno: http:// moz.gov.ua/docfi les/dn_20151230_0916dod_ukp.pdf
Blazowski L, Majak P, Kurzawa R. et al. Food allergy endotype with high risk of severe anaphylaxis in children-Monosensitization to cashew 2S albumin Ana o 3. Allergy. 2019; 74 (10): 1945–1955. https://doi.org/10.1111/all.13810
Berti I, Badina L, Cozzi G et al. Early oral immunotherapy in infants with cow’s milk protein allergy. Pediatr Allergy Immunol. 2019; 30,572–574. https://doi.org/10.1111/pai.13057
Ruinemans-Koerts J, Schmidtt-Hieljes Y, Jansen A et al. The basophil activation test reduces the need for a challenge test in children suspected of IgE mediated cow’s milk allergy. Clin Exp Allergy. 2019; 49, 350–356. https://doi.org/10.1111/cea.13307
Pochynok TV, Barzylovych VD, Barzylovych AD. Profilaktyka ta likuvannia hastrointestynalnykh proiaviv kharchovoi alerhii u ditei pershoho roku zhyttia, alerhiia do bilkiv koroviachoho moloka. ScienceRise. Medical science. 2016; 12: 4–9. [In Ukrainian].
Okhotnikova OM, Hladush YuI, Bondarenko LV ta in. Hastrointestynalna forma kharchovoi alerhii u ditei — aktualna problema suchasnosti. Zdorove rebenka. 2015; 3: 20–26. [In Ukrainian].
Nowak-Wegrzyn A, Chehade M, Groetch ME et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-workgroup report of the adverse reactions to foods committee, American Academy of Allergy, Asthma & Immunology. J. Allergy Clin. Immunol. 2017, 139, 1111–1126. https://doi.org/10.1016/j.jaci.2016.12.966
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