Relationship Between Clinical and Laboratory Criteria and Results of Double Blind Placebo Controlled Food challenge (DBPCFC) for the IgE Mediated Cow's Milk Allergy Diagnosis in Pediatric Patients

Abstract

RATIONALE: To describe the relationship between clinical, epidemiological, laboratory data and the DBPCFC for the IgE mediated cow's milk allergy (CMA) diagnosis. METHODS: It was performed 58 DBPCFC in patients aged 1-18 years, divided into two groups: group 1 (n = 39), 1.6 M:F, with a suggestive CMA and group 2 (n = 19), 1.4 M:F with inconsistent complaints of CMA. It was excluded patients with recent anaphylaxis or uncontrolled asthma. The criterium adopted for positive SPT was a wheal ≥ to 3 mm and ImmunoCAP ≥ 3.5 kU/L. The personal and family history of atopy were described in frequency and confidence interval and compared by Fisher's test. The eosinophil count, IgE levels and specific IgE to cow's milk and fractions: skin prick test (SPT) and ImmunoCAP were described by medians and the comparison between groups was done by Mann-Whitney test. The significance level was 5%. RESULTS: There was a significant association between positive DBPCFC and history of atopic disease (p= 0.037), positive DBPCFC and SPT: fresh LV (p <0.001), LV (p <0.001), betalactoglobulin (p <0.001) and casein (p = 0.04) and positive DBPCFC and ImmunoCAP for LV, betalactoglobulin and casein (p <0.001); besides alphalactoalbumin (p = 0.001). CONCLUSION: This study suggests the possibility of developing a score for CMA diagnosis including epidemiological, clinical and laboratorial findings that could eliminate the need to perform DBPCFC in a significant number of children.