Elimination and provocation test in cow's milk hypersensitive children
Keywords:
hypersensitivity, milk, immuglobulin E, child
Abstract
Background Allergic disease in infancy mostly related to cow'smilk allergy. The prevalence of cow's milk hypersenstivity in chil-
dren has increased steadily in the past years; therefore diagnostic
accuracy is important and every symptomatic child with positive
specific lgE should be followed by elimination and provocation.
Objective To diagnose cow's milk hypersensitivity on children un-
der three years old using elimination and provocation methods.
Methods This was a clinical diagnosis study, in which children
with allergy symptoms were examined for cow's milk sensitivity
using prick test or lgE Radioallergosorbent test (RAST). Those
with positive results underwent an elimination for minimal of 2
weeks and were challenged aterwards. The study was a qualitative
diagnostic test with the gold standard of recurrence of symptoms
after challenge test.
Results There were forty subjects included in the challenge pro-
cess with mean age of 17 months old. Boys and girls were equally
distributed. There were 6 7% subjects with positive results on
challenge with positive prick test and 64% positive challenge with
history of positive lgE RAST. Sixty-five percents of subjects with
positive results on challenge had more than 2 weeks elimination
period. There was no statistical significance found in children
with positive results on challenge, using neither prick test or
lgE RAST.
Conclusions Cow's milk protein allergy can be diagnosed on chil-
dren less than 3 years old by applying elimination and challenge
procedure. lgE sensitivity alone can not determine hypersensitivity
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Sachs Metal. Double blind placebo controlled food challenge
(DBPCFC) as an office van Bever H. Preventive tretment of
childhood asthma. APAPARI-KAPARD Joint Congress. Seoul,
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to milk in children with cow's milk hypersensitivity. Journal
of Pediatrics 2004; 144:218-22.
15. Eggesbo M, Halvorsen R, Tambs K. Prevalence of parentally
perceived adverse reaction to food in young children. Pediatr
Allergy Immunol1999; 10:122-32.
16. Host A., Halken S. A prospective study of cow's milk allergy
in Danish infants during the first 3 years of life. Allergy
1990;45:587 -96.
17. Host A. Cow's milk protein allergy and intolerance in infancy.
Some clinical, epidemiological and immunological aspects.
Pediatr Allergy Immunol 1994;5: 1-3.
18. Sampson HA. Food allergy. Part 2: diagnosis and management.
J AllergyClinimmunol1999;103:981-9.
19. Molkhou P. Food allergies, present and future problems.
Belgium, The UCB Institute of Allergy.2000:4 7.
20. Zeiger RS, Sampson HA, Bock SA. Soy allergy in infants
and children with IgE-associated cow's milk allergy. J Pediatr
1999; 134:614-22.
21. Hosking CS, Heine RG, Hill DJ. The Melbourne Milk Allergy
study-two decades of clinical research. Allergy Clin Immunol
Internat 2000; 12:198-205.
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hood, J Pediatr 1992;121:4-6.
2005;2:1-7.
2. Muraro A, Dreborg S, Halken S, H!bst A, Niggemann B,
Aalberse R, et al: Dietary prevention of allergic diseases in
infant and small children Part III: Critical review of published
peer-reviewed observational and interventional studies and fi-
nal recommendation. Pediatr Allergy Immunol2004; 15:291-
307.
3. Sampson HA. Adverse reactions to foods. Dalam: Middleton
E, Reed CE, Elliot EF, Adkinson NF, Yunginger JW, Busse
WW, penyunting. Allergy, Principle and Practice. 4th edition.
St. Louis, Mosby, 1993:1661-86.
4. Host A. Halken S. Approach to feeding problems in the infant
and young child. In: Leung DYM, Sampson HA, Geha RS,
Szefler SJ. Pediatric Allergy principles and practice. Missouri,
Mosby, 2003:488-94.
5. Ebisawa M, Sugizaki C, Ikeda Y, Tachimoto H. Development
of food allergy during infancy. APAPARI-KAPARD Joint
congress. Seoul, Korea. April 2005.
6. Sampson HA. Food allergy. Part I: Immunopathogenesis and
clinical disorders. J Allergy Clin Immunol1999; 103:717-28.
7. Burks A W, James JM, Hiegel A, Wilson G, Wheeler JG, Jones
SM, Zuerlein N. Atopic dermatitis and food hypersensitivity
reactions. Journal of Pediatrics 1998; 132:132-6.
8. Sicherer Sh, Sampson HA. Food hypersensitivity and atopic
dermatitis: pathophysiology, epidemiology, diagnosis and
management. J Allergy Clin Immunol 1999; 104: 114-22.
9. Hill DJ, Duke AM, Hosking CS, Hudson IL. Clinical manifesta-
tions of cow's milk allergy in childhood: II. The diagnosis value
of skin tests and RAST. Clinical Allergy 1988;18:481-90.
10. William LW, Bock SL. Skin testing and food challenges for
evaluation of food allergy. Immunol Allergy Clin N Amer
1999; 19:4 79-93.
11. Isolauri E, Turjanmaa K . Combined skin prick and patch
testing enhances identification of food allergy in infants with
atopic dermatitis. J Allergy Clin Immunol 1996;97 :9-15.
12. Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S,
Sachs Metal. Double blind placebo controlled food challenge
(DBPCFC) as an office van Bever H. Preventive tretment of
childhood asthma. APAPARI-KAPARD Joint Congress. Seoul,
Korea. April 2005.
13. Bishop MJ, Hasting. Natural history of cow's milk allergy.
Clinical outcome. J Pediatr 1990; 116:862-7.
14. Van toT, Helpplia S, Juntunen-Backman K, Kalimo K, Klem-
ola T, Korpela R. Prediction of the development of tolerance
References
to milk in children with cow's milk hypersensitivity. Journal
of Pediatrics 2004; 144:218-22.
15. Eggesbo M, Halvorsen R, Tambs K. Prevalence of parentally
perceived adverse reaction to food in young children. Pediatr
Allergy Immunol1999; 10:122-32.
16. Host A., Halken S. A prospective study of cow's milk allergy
in Danish infants during the first 3 years of life. Allergy
1990;45:587 -96.
17. Host A. Cow's milk protein allergy and intolerance in infancy.
Some clinical, epidemiological and immunological aspects.
Pediatr Allergy Immunol 1994;5: 1-3.
18. Sampson HA. Food allergy. Part 2: diagnosis and management.
J AllergyClinimmunol1999;103:981-9.
19. Molkhou P. Food allergies, present and future problems.
Belgium, The UCB Institute of Allergy.2000:4 7.
20. Zeiger RS, Sampson HA, Bock SA. Soy allergy in infants
and children with IgE-associated cow's milk allergy. J Pediatr
1999; 134:614-22.
21. Hosking CS, Heine RG, Hill DJ. The Melbourne Milk Allergy
study-two decades of clinical research. Allergy Clin Immunol
Internat 2000; 12:198-205.
22. Walker W A. Adverse reactions to food in infancy and child-
hood, J Pediatr 1992;121:4-6.
Published
2008-08-31
How to Cite
1.
Safri M, Kurniati N, Munasir Z. Elimination and provocation test in cow’s milk hypersensitive children. PI [Internet]. 31Aug.2008 [cited 5Nov.2024];48(4):253-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/577
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Received 2016-09-10
Accepted 2016-09-10
Published 2008-08-31
Accepted 2016-09-10
Published 2008-08-31
