ЗНАЧЕНИЕ ОРАЛЬНЫХ ПИЩЕВЫХ ПРОВОКАЦИОННЫХ ПРОБ В ВЕДЕНИИ ДЕТЕЙ С АТОПИЧЕСКИМ ДЕРМАТИТОМ

Abstract

One of the important tasks in the management of children with atopic dermatitis (AD) is the assessment of tolerance to previously excluded foods. An oral provocative test is considered to be the «gold standard» of confirming/excluding the presence of food allergies (FA), but food provocative trials are a potentially dangerous method of diagnosis. Objective of the study: to evaluate the feasibility of using oral provocative tests when expanding the diet in children with AD and allergy to cow's milk proteins (CMP). Materials and methods of research: a single-center cohort retrospective study was conducted. 154 patients with AD aged from 1 to 17 years had an oral provocation test with cow's milk for assessing the informativity of the concentration of IgE specific to CMP. At the first stage of the study, the incidence of symptoms, the time of onset of reactions, and the frequency of delayed reactions were assessed. The second step was to analyze the diagnostic informativeness of concentration of specific IgE to CMP in order to determine the value of the IgE-specific concentration, in which a provocative test to introduce cow’s milk into the diet would be the safest. To detect sensitization in all patients, the concentrations of specific IgE (ImmunoCAP Fadia test system) in blood serum to CMP were preliminarily determined. The result was considered positive when the values of the concentration of specific IgE>0.35 IU/ml. Results: a positive result of the provocative test was observed in 44 (28.6%) patients, delayed-type reactions – in 24 (54.5%). CMP-Specific IgE was detected in 62 (40.2%) of 154 patients, of which a positive result of provocative tests was observed in 16 (25%) children. In 92 patients, the concentration of CMP-Specific IgE was below 0.35 kU/l, of which a positive provocative test result was observed in 28 (30%). The probability of a positive result at a concentration of specific IgE ≤0.35 kU/l is 25.8%, at a concentration above 1.5 kU/l – 40%, at a concentration above 2.0 kU/l – 61.5%. Conclusion: oral provocation tests are a necessary component in the management of children with AD induced by FA. This technique should be used not only to confirm the diagnosis of FA, but also when introducing products into the diet.