Nasal mucosal reactivity assessment via a double-blind placebo-controlled food challenge with cow’s milk allergens

Abstract

Background Allergies, including food allergies, are a considerable clinical and public-health problem. The introduced preventive measures and differential diagnostics, including oral food challenges, are the gold standard for determining further treatment planning. Case presentation We present a case of an 18-year-old girl with a cow’s milk allergy who underwent an oral food challenge (double blind oral food challenge). Such a challenge may be confounded by inducing a response from other systems and organs, which provides theoretical grounds for the use of other methods of assessing the body’s response to food allergens (response demonstrated by the upper respiratory tract). Based on this idea, in order to assess the degree of mucosal response, we used optical rhinometry as an objective method for nasal patency evaluation, as well as identification of tryptase level in nasal lavage fluid and exfoliative cytology of nasal mucosa. The results of these tests confirmed positive reaction of the nasal mucosa in the course of the oral allergen challenge. Conclusions The observed increase in the nasal mucosal reactivity that accompanies oral food challenges may suggest a potential for using food allergens in nasal allergen provocation testing in order to diagnose food allergies.

Oral and nasal provocation test in chicken egg allergy—case report

“…The results confirmed the usefulness of NPT in the diagnosis of food allergy to shrimp [ 21 ]. The work of Gelis et al was an inspiration for our team, and in our study in 2020 we confirmed the reactivity of the nasal mucosa during the oral provocation test with cow's milk protein allergens [ 22 ]. In our current study in the diagnosis of food allergy, in addition to the recognized diagnostic method (i.e., DBPCFC), we used a new diagnostic method (NPT) with chicken egg protein, and confirmed its effectiveness and safety.…”