Ocena przydatności doustnej prowokacji pokarmowej metodą podwójnie ślepą kontrolowaną placebo u dzieci leczonych eliminacyjną dietą bezmleczną

Abstract

IntroductionThe gold standard for the diagnosis of food allergy is a double-blind placebo-controlled food challenge (DBPCFC). Open food challenge is recommended in younger children because of the limited impact of symptoms subjectivization during its duration. AimThe aim of the study was the assessment of usefulness of DBPCFC in confirmation of tolerance to cow's milk proteins after a period of elimination diet in children with a positive result of the open challenge and evaluation of the clinical cow's milk allergy symptoms in children. Material and methodsThe analysis included the medical records of 80 children between 7 and 48 months of age using dairy-free diet. After a period of elimination diets and resolution of clinical signs in these patients open provocation tests were conducted, the results of which were positive. For this reason, they have been qualified for DBPCFC in order to confirm or rule out the persistence of allergy to cow's milk proteins. ResultsThe application of DBPCFC method allowed to rule out allergy to cow's milk proteins in 80% of the children. The elimination diet has been used for an average of 13.18 months, it was more often based on the whey hydrolysate. The average age of patients was 18.7 months. An analysis of the clinical symptoms showed that the most common form was atopic dermatitis (76.25%). ConclusionsDBPCFC is an effective method of showing the children's acquisition of tolerance for cow's milk proteins (which were not tolerated earlier) after a period of elimination diet; the method has a high clinical value. A strong influence of parent's emotional factors on the objective assessment of clinical reactions of the child is an argument for using blind trials.