The Value Of Open Food Challenge For The Diagnosis And Treatment Of Cow’s Milk Protein Allergy In Infants

Objective: Recently, the prevalence of allergic diseases worldwide is rising dramaticallyin both developed and developing countries. Cow’s milk protein allergy is the most commonfood allergic diseases in children, and the incidence has increased significantly in recent years.The clinical manifestation of cow’s milk protein allergy is complex and variable, so earlyidentification and diagnosis are very important in the management of the disease. In this study,we focus on the role of food challenge in the diagnosis and treatment of cow’s milk proteinallergy.Methods: It is a retrospective analysis of thirty-five children with suspected cow’s milkprotein allergy who attended the clinic of the pediatric gastroenterology department, the FirstHospital of Jilin University from March2014to October2014. They were divided into thebreastfeeding and AAF feeding groups. Upon follow-up, analyses were made on their familyhistory, personal history, feeding conditions, clinical manifestations, diagnosis (cow’s milkprotein avoidance/food challenge), and the value of food challenge in sequential therapy.Results:35children with suspected CMPA enrolled into the study. The male to femaleratio is1.19:1. Among them,7cases (20%) were on exclusively breast feeding;15cases(42.86%), artificial feeding; and13cases (37.14%), mixed feeding. The age of highestincidence is1-3months (16cases,45.71%). The course of disease ranged from7days to tenmonths. There are21cases (60%) with family history of allergy. Clinical manifestations ofthe35patients are various and involved different organ systems, including the digestivesystem, skin, and respiratory system. Digestive symptoms are: vomiting, diarrhea andgastrointestinal hemorrhage (30cases,85.71%).12cases (34.29%) have eczema. Respiratory symptoms manifested mainly as cough (1case,2.86%).4cases had atypical manifestationscomprising milk refusal and crying (11.43%). Of the35cases,18demonstrated varyingdegrees of cardiac enzymes elevation and15cases, transaminase elevation. After avoidanceof cow’s milk protein for a certain period, oral food challenge tests are positive in all patients.In the breastfeeding group, after three months of breast feeding without cow’s milk protein,57.14%are also positive. In the AAF feeding group, of the28cases of children, after threemonths of therapeutic formula feeding, oral food challenge test was positive in23of themwhile5patients were negative. These23patients accepted an additional period of treatmentof therapeutic-formula for three more months. Then11cases became negative while12casesremained positive.Conclusion: The clinical manifestations of CMPA are variable and different systemscould present as the initial symptoms. Clinical awareness of this disease is particularlyimportant in early diagnosis. Early identification, diagnosis and treatment can reduce theinfants’ sufferings and their families’ anxiety. Some infants with CMPA have varying degreesof elevation of cardiac enzymes and transaminases, the mechanism of which is unclear andfurther studies are warranted. Food avoidance and oral food challenge are the most importantbasis for the diagnosis of CMPA. This method is accurate, but it should be conducted bymedical professionals in medical institutions with available emergency resuscitation measures.Food challenge plays an important role in the sequential management of CMPA, and it can beused to observe the tolerance of CMP. It is effective to choose either AAF or eHF in thetreatment of CMPA. All clinical symptoms are alleviated in a week, and they are welltolerated.