Positive Milk Challenge Research Articles

Food allergy in children with refractory gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) and food allergy are frequent disorders of childhood. The purpose of this study was to determine the frequency of food allergy in children with refractory GERD. A total of 151 children resistant to pharmacologic GERD treatment underwent skin prick test, specific immunoglobulin E, eosinophil count, atopy patch test (APT), and oral food challenge, and were then divided into three groups according to the results of oral milk challenge and allergy work-up: group A1, positive oral milk challenge and positive IgE-mediated allergy test; group A2, positive milk challenge and negative IgE-mediated allergy test; and group B, negative oral milk challenge and negative allergy tests. There were 35, 30 and 86 patients in group A1, group A2 and group B, respectively. A total of 28 of 35 patients in group A1 had cow's milk allergy and the other seven patients had egg allergy. APT positivity was more common in group A2. Endoscopic esophagitis was observed in six group A1 patients and in four group A2 patients. Bloody stools, atopic dermatitis and recurrent wheezing episodes were significantly more common in group A1 than in group A2 and group B (P < 0.001, for both). Cow's milk allergy was observed frequently in children resistant to pharmacologic GERD treatment. Combined skin prick and specific IgE tests, APT and oral food challenge is essential for avoidance of unnecessary elimination diet.

EVALUATION OF HYPOALLERGENICITY OF VARIOUS INFANT FORMULA USING TNFα RELEASED FROM MONONUCLEAR CELLS OF COW'S MILK ALLERGIC CHILDREN.

We have recently shown that the peripheral blood mononuclear cells of infants with active cow's milk allergy (CMA) -but not those of tolerant infants- secreated high amounts of TNFα, when stimulated specifically with intact milk proteins. TNFα was also shown to alter the intestinal epithelial integrity. In the present study, we used the TNFα test to compare the reactivity of mononuclear cells to intact milk proteins, unprocessed infant formula, extensively hydrolyzed whey or casein formula, soya-based formula and an amino acid-based formula. Methods: blood samples were collected just before a late milk challenge from 25 cow's milk allergic infants who were maintained on a cow milk free diet for several months. Peripheral blood mononuclear cells (PBMC) were isolated and cultured at 106 cells/ml for 24 hours without stimulation, or in the presence of intact cow milk proteins (βlactoglobulin, α-lactalbumin, casein, 50μg/ml of each) or various infant formula containing extensively hydrolyzed whey proteins or casein, soya proteins or an amino-acid based formula. TNFα was assayed in culture supernatants. Results: According to clinical observations, 18 children had a positive milk challenge: in these children, unstimulated PBMC secreted low amounts of TNFα (129±34 pg/ml) compared to PBMC stimulated with intact milk proteins (693±77 pg/ml, p<0.0001) or with unprocessed formula (727±67. p<0.0001). According to the TNFα test, among the infant formula tested, the amino acid-based formula Neocate behaved as the less allergenic (TNFα =105±38 pg/ml, not different from unstimulated condition). The other hypoallergenic milk or soya-based formula induced an intermediate secretion ranging from 155±36 pg/ml (Nutramigen) to 572±102 pg/ml (Pregomine). These results indicate that the TNFα release test is a useful and sensitive test reflecting the reactivity of peripheral mononuclear cells to food antigens, that can be considered as relevant in measuring the hypoallergenicity of infant food formula.

Cows' milk-sensitive enteropathy.

Serial small intestinal biopsies related to withdrawal and challenge with cows' milk are described in 5 infants with cows' milk protein intolerenace. On the basis of these serial observations the existence of a cows' milk-sensitive enteropathy in infancy is clearly established. The cows' milk-sensitive mucosal lesion varied in its severity ranging from a partly flat mucosa to a mild degree of partial villous atrophy. Intraepithelial lymphocyte counts rose after a positive milk challenge, but on only one occasion to a level outside the normal range. The technique of serial biopsies related to dietary milk enables a firm diagnosis of cows' milk intolerance to be made upon the basis of a single milk challenge. Clinically this appears to be a temporary condition which disappears by the age of 2 years.