Open challenge for the diagnosis of cow's milk protein allergy

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Nutrition
• Immunology

Background:

• Cow's milk allergy (CMA) is common in infants and children.
• Exclusion diets are standard management, but prolonged unnecessary restriction can impact nutrition.
• Reintroduction of cow's milk protein is crucial for tolerance development.

Purpose of the Study:

• To evaluate the results of supervised open cow's milk challenge tests in children on a cow's milk-free diet.
• To determine the rate of positive challenges and clinical outcomes.
• To assess the feasibility of discontinuing exclusion diets based on challenge results.

Main Methods:

• A cross-sectional study involving 121 children (4-95 months) on cow's milk-free diets.
• Supervised open cow's milk challenge tests conducted in a hospital setting with 30-day ambulatory follow-up.
• Analysis of challenge results, clinical manifestations, and types of prior exclusion diets.

Main Results:

• Cow's milk open challenge tests were positive in 28.1% of patients (23.1%).
• Among those with positive challenges, 24.9% showed different clinical manifestations than at diagnosis.
• Positive challenges were more frequent in infants fed extensively hydrolyzed or amino acid-based formulae (30.3%) compared to other exclusion diets (14.5%).

Conclusions:

• Open challenge tests are effective in identifying children who can safely reintroduce cow's milk.
• The procedure allows for the discontinuation of exclusion diets in a significant proportion of patients.
• Supervised challenges are a valuable tool in managing cow's milk allergy.