Guidelines on Diagnosis and Management of Cow’s Milk Protein Allergy

Matthai, John; Sathiasekharan, Malathi; Poddar, Ujjal; Sibal, Anupam; Srivastava, Anshu; Waikar, Yogesh; Malik, Rohan; Ray, Gautam; Geetha, S; Yachha, Surender Kumar

doi:10.1007/s13312-020-1916-5

Cited by 30 publications

(53 citation statements)

References 19 publications

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“…The main advantage of a basophil activation test over IgE-specific antibodies is its high specificity, which supports the diagnosis of FA when the test is positive [8]. For instance, basophil activation in a test for peanut allergies showed a specificity of 96% in a discovery cohort and 100% specificity in a validation cohort [43].…”

Section: Basophil Activation Testmentioning

confidence: 95%

“…A skin prick test consists of the insertion/inoculation of a small amount of allergen into the surface layer of the skin in order to evaluate the body's response to the allergen tested. Skin tests can be performed even in infants from the age of six months [43]. Medications such as antihistamines, antiallergics, or steroids should be discontinued at least three days before a prick test [1,6].…”

Section: Skin Prick Tests (Spt)mentioning

confidence: 99%

“…The role of this test is primarily diagnostic. By identifying the causal allergen, the definite diagnosis of an FA and infantile atopic dermatitis associated with an FA can be established [43,44]. By identifying the threshold level at which the symptoms appear, the oral challenge test has an important role in the desensitization process by determining the safe dose of foods [43,45].…”

Section: Ofc Testmentioning

confidence: 99%

“…By identifying the causal allergen, the definite diagnosis of an FA and infantile atopic dermatitis associated with an FA can be established [43,44]. By identifying the threshold level at which the symptoms appear, the oral challenge test has an important role in the desensitization process by determining the safe dose of foods [43,45]. The test result may be influenced by certain doses of drugs, which is why it is necessary to discontinue treatment before investigating (Table 3).…”

Section: Ofc Testmentioning

confidence: 99%

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Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Sur

Armat

Duca

et al. 2021

Life

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Food allergy (FA) is a condition with a growing incidence and is a constant concern for the medical world and healthcare providers. With potential symptoms including anaphylaxis, in the event of an allergic reaction the patient’s life may well be endangered. The diagnosis of FA is a continuous challenge because mild cases tend to be ignored or diagnosed late and young children with allergies are cared for by parents, who are not always able to accurately interpret symptoms. It is very important to be able to differentiate FAs from food intolerance and toxic reactions to food. An accurate diagnosis is required to provide personalized management of an FA. More sophisticated and accurate diagnostic tests, including component diagnosis and epitope reactivity, allow the provision of a directed diagnosis, a more accurate therapeutic approach, and a useful prognostic evaluation. Tests used in current practice include the specific search for serum IgE, elimination diets, oral food challenges, single, blind, and double-blind (DBPCFC) tests, as well as skin tests. The risk of anaphylaxis can be assessed by molecular diagnostics/component-resolved diagnosis (CRD) and by conducting a basophilic activation test (BAT). These tests allow a planned, personalized treatment based on molecular and clinical profiles. CRD can determine the individual profile of allergic molecular reactivity and enable the formulation of a prognostic judgment. Our article highlights the importance of knowing the immune mechanisms, diagnostics, and immunotherapies in FAs. Starting from observing exposure to food allergens, to identifying allergic reactions, analysing the severity of clinical manifestations, noting the possibilities of diagnosis, and illustrating adequate management strategies.

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Section: Basophil Activation Testmentioning

confidence: 95%

Section: Skin Prick Tests (Spt)mentioning

confidence: 99%

Section: Ofc Testmentioning

confidence: 99%

Section: Ofc Testmentioning

confidence: 99%

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Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Sur

Armat

Duca

et al. 2021

Life

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“…indicative of a milk protein allergy were observed, the infants were prevented from consuming milk protein in the diet for two weeks, and an oral food challenge test was subsequently conducted. The oral challenge was considered to be positive when there were skin (urticaria, angioedema or erythematous rash), digestive (vomiting or diarrhea), respiratory (rhino-conjunctivitis or bronchospasms) or generalized (anaphylactic shock) manifestations after the intake of the milk formula [ 23 , 24 ], and the diagnosis of milk protein allergy was confirmed [ 25 ]. After a positive oral food challenge test, stool samples of infants with a diagnosis of milk protein allergy were collected for testing.…”

Section: Methodsmentioning

confidence: 99%

Can fecal calprotectin levels be used to monitor infant milk protein allergies?

Qiu

Wang

Ren

et al. 2021

Allergy Asthma Clin Immunol

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Background Milk protein allergy is one of the most common food allergies in infants. We aimed to test whether fecal calprotectin can be used to monitor food allergies in infants by comparing the fecal calprotectin levels in infants with a milk protein allergy before and after an intervention treatment. Methods The study was designed as a prospective case–control trial. Stool samples were collected at follow-up, and the concentration of fecal calprotectin was determined using an enzyme-linked immunosorbent assay. The infant’s weight and length were measured. Results The allergic group comprised 90 milk-allergic infants (41 boys, 49 girls), and the nonallergic group comprised 90 nonallergic infants (51 boys, 39 girls). Compared with the fecal calprotectin level in the nonallergic group (median: 141 μg/g), that in the allergic group (median: 410 μg/g) was significantly higher (z = − 9.335, p < 0.001). After two dietary interventions and treatments, the fecal calprotectin levels of the infants with a milk protein allergy at the first (median: 253 μg/g) and second follow-up visits (median: 160 μg/g) were significantly lower than those before the intervention (z = − 7.884, p < 0.001 and z = − 8.239, p < 0.001, respectively). The growth index values (LAZ and WAZ) of the infants with a milk protein allergy at the first and second follow-up visits were significantly higher than those before dietary intervention (p < 0.05). Fecal calprotectin was negatively and significantly correlated with the WLZ and WAZ at the second follow-up visit (Spearman’s rho = − 0.234, p = 0.01 and Spearman’s rho = − 0.193, p = 0.03, respectively). Conclusion The level of fecal calprotectin in infants with a milk protein allergy decreased after dietary intervention and seems to be a promising biological indicator for monitoring intestinal allergies.

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Clinical characteristics, laboratory findings, and tolerance acquisition in infants with cow's milk protein allergy in a private center in Lima, Peru for the period 2021–2022

Calle,

Díaz‐Vásquez,

Córdova‐Calderón

et al. 2024

Immunity Inflam & Disease

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BackgroundCow's milk protein allergy (CMPA) remains relatively understudied in Latin America.MethodsIn this observational study, we enrolled 64 patients with a median age of 3 months, of whom 60% were male. Patients included had a history of IgE‐mediated reactions with IgE sensitization or non‐IgE‐mediated reactions or symptoms following exposure to cow's milk. They underwent skin prick test, ImmunoCAP, fecal calprotectin (FC), and fecal eosinophil‐derived neurotoxin (EDN), in addition to double‐blinded placebo‐controlled oral food challenges (DBPCFC), with clinical evolution and tolerance acquisition observed over 1 year.ResultsMalnutrition was present in 78.1% of patients, and 87.5% had a family history of atopy, with 51.6% receiving exclusive breastfeeding. Gastrointestinal manifestations were prevalent in 90.6% of patients, followed by dermatological manifestations (10.9%), with only 2 experiencing anaphylaxis. IgE‐mediated CMPA was observed in only six patients. In those with non‐IgE‐mediated CMPA, FC had a median of 284 mg/dL (IQR: 138.5–415.5), while EDN had a median of 508.5 mg/dL (IQR: 160.25–868). One year after diagnosis, median FC significantly decreased (p < 0.0001), and malnutrition prevalence reduced to 17.1%. Moreover, 81% of patients acquired tolerance following DBPCFC, with 52% utilizing nutritional replacement formulas at diagnosis. Notably, 94% of those extensively hydrolyzed casein‐based formulas achieved tolerance (p = 0.08).ConclusionOur findings provide a foundational framework for future investigations into CMPA diagnosis, tolerance acquisition, and the utilization of hypoallergenic formulas tailored to the unique characteristics of our region.

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Guidelines on Diagnosis and Management of Cow’s Milk Protein Allergy

Cited by 30 publications

References 19 publications

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Can fecal calprotectin levels be used to monitor infant milk protein allergies?

Clinical characteristics, laboratory findings, and tolerance acquisition in infants with cow's milk protein allergy in a private center in Lima, Peru for the period 2021–2022

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