Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy

Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: Prevention of unnecessary elimination diets and determination of eliciting doses

Dambacher, W.M.
de Kort, E.H.M.
Blom, W.M.
Houben, G.F.
de Vries, E.

2013

Background: Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. Methods. All children with suspected CMA under our care (Oct'05 - Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. Results: 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Conclusions: Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers. © 2013 Dambacher et al; licensee BioMed Central Ltd.

EELS - Earth, Environmental and Life Sciences
Life
Healthy Living
Food and Nutrition
Cow's milk allergy
Cow's milk protein
Double-blind placebo-controlled provocation
Milk hypersensitivity
Minimum eliciting dose
food allergen
milk protein
abdominal pain
adverse outcome
allergic reaction
article
artificial milk
child
colic
constipation
controlled study
diarrhea
diet
double blind procedure
dyspnea
eczema
feeding disorder
female
human
infant
infant feeding
major clinical study
male
milk allergy
pathological crying
preschool child
prospective study
provocation test
randomized controlled trial
rash
rectum hemorrhage
school child
swelling
urticaria
vomiting
wheezing
QS - Quality & Safety

http://resolver.tudelft.nl/uuid:1ecd6351-03c6-4b93-8f8a-a3b7ded8962f

https://doi.org/10.1186/1475-2891-12-22

471485

1475-2891

Nutrition Journal, 12 (12)

article