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A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy
OBJECTIVE: A challenge is the recommended test to diagnose cow’s milk protein allergy. However, many parents and physicians prefer to not challenge because the procedure may cause (severe) symptoms. In clinical routine, diagnostic testing is only available for IgE-mediated allergy. The aim of this s...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607180/ https://www.ncbi.nlm.nih.gov/pubmed/26770708 http://dx.doi.org/10.1177/2050312114523423 |
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author | Vandenplas, Yvan Steenhout, Philippe Grathwohl, Dominik |
author_facet | Vandenplas, Yvan Steenhout, Philippe Grathwohl, Dominik |
author_sort | Vandenplas, Yvan |
collection | PubMed |
description | OBJECTIVE: A challenge is the recommended test to diagnose cow’s milk protein allergy. However, many parents and physicians prefer to not challenge because the procedure may cause (severe) symptoms. In clinical routine, diagnostic testing is only available for IgE-mediated allergy. The aim of this study was to test the diagnostic accuracy of a symptom-based score to select infants at risk of having cow’s milk protein allergy. METHODS: A symptom-based score was developed and consensus was reached that a score of ≥12 would select infants at risk of cow’s milk protein allergy. Diagnosis of cow’s milk protein allergy was demonstrated with a positive challenge after 1-month elimination diet. RESULTS: An open challenge was performed in 85/116 (73%) infants suspected of cow’s milk protein allergy based on a symptom-based score ≥ 12 and was positive in 59/85 (69%). Although “a challenge test” was planned in the protocol, 27% of the parents refused the challenge. The mean decrease after 1 month of elimination diet with an extensive hydrolysate was −8.07 (95% confidence interval = −8.74, −7.40). If the symptom-based score during the elimination diet decreased to 6 or lower, 80% of the infants had a positive challenge test. If the symptom-based score remained >7, the challenge test was positive in only 48% (p < 0.001). CONCLUSION: In daily practice, a symptom-based score of ≥12 is a useful tool to select infants at risk of cow’s milk protein allergy. If an elimination diet reduces the symptom-based score to ≤6, the challenge test is positive in 80%. |
format | Online Article Text |
id | pubmed-4607180 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-46071802016-01-14 A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy Vandenplas, Yvan Steenhout, Philippe Grathwohl, Dominik SAGE Open Med Original Article OBJECTIVE: A challenge is the recommended test to diagnose cow’s milk protein allergy. However, many parents and physicians prefer to not challenge because the procedure may cause (severe) symptoms. In clinical routine, diagnostic testing is only available for IgE-mediated allergy. The aim of this study was to test the diagnostic accuracy of a symptom-based score to select infants at risk of having cow’s milk protein allergy. METHODS: A symptom-based score was developed and consensus was reached that a score of ≥12 would select infants at risk of cow’s milk protein allergy. Diagnosis of cow’s milk protein allergy was demonstrated with a positive challenge after 1-month elimination diet. RESULTS: An open challenge was performed in 85/116 (73%) infants suspected of cow’s milk protein allergy based on a symptom-based score ≥ 12 and was positive in 59/85 (69%). Although “a challenge test” was planned in the protocol, 27% of the parents refused the challenge. The mean decrease after 1 month of elimination diet with an extensive hydrolysate was −8.07 (95% confidence interval = −8.74, −7.40). If the symptom-based score during the elimination diet decreased to 6 or lower, 80% of the infants had a positive challenge test. If the symptom-based score remained >7, the challenge test was positive in only 48% (p < 0.001). CONCLUSION: In daily practice, a symptom-based score of ≥12 is a useful tool to select infants at risk of cow’s milk protein allergy. If an elimination diet reduces the symptom-based score to ≤6, the challenge test is positive in 80%. SAGE Publications 2014-02-13 /pmc/articles/PMC4607180/ /pubmed/26770708 http://dx.doi.org/10.1177/2050312114523423 Text en © The Author(s) 2014 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(http://www.uk.sagepub.com/aboutus/openaccess.htm). |
spellingShingle | Original Article Vandenplas, Yvan Steenhout, Philippe Grathwohl, Dominik A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title | A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title_full | A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title_fullStr | A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title_full_unstemmed | A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title_short | A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
title_sort | pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607180/ https://www.ncbi.nlm.nih.gov/pubmed/26770708 http://dx.doi.org/10.1177/2050312114523423 |
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