Oral Provocation Test on the Diagnosis of Cow's Milk Protein Allergy in Children: Integrative Review
Keywords:Allergy, Food hypersensitivity, Cow milk, Child, Diagnosis.
Introduction: The cow's milk protein allergy (CMPA) is considered the most prevalent food allergy in children, developing, usually, during the first three years of life and can cause gastrointestinal, respiratory and skin changes. Among the diagnostic methods used, there is the oral food challenge test. However, little used in clinical practice.
Objective: Identifying the importance of Oral Provocation Test (OPT) in the diagnostic confirmation of CMPA in children.
Method: An integrative review of studies of the last ten years, with six relevant articles related to the theme and used and described the OPT in children with suspected CMPA.
Results: The OPT is important to confirm the diagnosis, avoiding prolonged exclusion diets, nutritional risks and unnecessary expenses. The oral test with milk can be adopted as the gold standard and used as a basis for comparative studies that aims to advance the molecular diagnosis, determining the specificities and sensitivities of such tests. It can also be used with other foods. In innovative studies to determine the tolerance of dairy foods, allowing include them in the feeding of these patients during the elimination diet.
Conclusion: It is important that the OPT is performed early in the onset of symptoms suggestive of CMPA, in order to avoid prolonged exclusion diets, nutritional risks and unnecessary expenses.
Orsi M, FernÃ¡ndez A, Follett FR, Marchisone S, Saieg G, Busoni VB, et al. Cow's milk proteÃn allergy. Proposed guidelines for the management of children with cow's milk protein allergy. Arch Argent Pediatr. 2009; 107 (5):459-70, 2009. Available from: <http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0325-00752009000500016&lng=es&nrm=iso.
Vera CH, Fernando J, RamÃrez VA. Gastrointestinal symptoms and clinical response of infants with cow's milk protein allergy. Rev chil pediatr. 2013; 84 (6):641-49. Available from: <http://www.scielo.cl/pdf/rcp/v84n6/art07.pdf>. Doi: http://dx.doi.org/10.4067/S0370-41062013000600007.
Sanchez-GarcÃa S, Rodriguez del RÃo P, Escudero C, Garcia-Fernandez C, Ramirez Ibanez MD. Efficacy of oral immunotherapy protocol for specific oral tolerance induction in children with cow's milk allergy. The Israel Medical Association journal: IMAJ. 2012; 14(1): 43-7. Available from: <http://www.ima.org.il/IMAJ/ViewArticle.aspx?year=2012&month=01&page=43>. doi: 10.1016/j.anai.2013.10.001
Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinell P. Cow's milk protein allergy in children: a practical guide. Ital J Pediat. 2010; 36 (5):1-7. Available from: <http://www.ijponline.net/content/pdf/1824-7288-36-5.pdf>. doi: 10.1186/1824-7288-36-5.
Dambacher WM, Kort EHM, Blom WM, Houben GF, Vries E. Double-blind placebo-controlled food challenges in children with alleged cowâ€™s milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses. Nutr J. 2013;12 (1):22. Available from: <http://www.nutritionj.com/content/12/1/22>. doi:10.1186/1475-2891-12-22.
Fiocchi A, Brozek J, SchuÂ¨nemann H, Bahna SL, Berg A, Beyer K, et al. World Allergy Organization (WAO) diagnosis and rationale for Action against Cow's Milk Allergy (DRACMA) guidelines. The World Allergy Organization Journal 2010; 3 (4):57-161. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488907/>. doi: 10.1186/1939-4551-6-1.
Vieira MC, Morais MB, Spolidoro JVN, Toporovski MS, Cardoso AL, Araujo GTB, et al. A survey on clinical presentation and nutritional status of infants with suspected cow'milk allergy. BMC pediatrics. 2010; 10(1):25. Available from: <http://www.biomedcentral.com/1471-2431/10/25>. doi:10.1186/1471-2431-10-25.
Fiocchi A, Bouygue GR, Albarini M, Restani P. Molecular diagnosis of cow's milk allergy. Curr Opin Allergy Clin Immunol. 2011 jun; 11(3):216-21. Available from: <http://www.ncbi.nlm.nih.gov/pubmed/21505327>. doi: 10.1097/ACI.0b013e32834694ef.
Bellini F, Ricci G, Dondi A, Piccinno V, Angelini F, Pession A. End point prick test: could this new test be used to predict the outcome of oral food challenge in children with cow's milk allergy?. Italian journal of pediatrics. 2011; 37(1):1-6. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220633/>. doi: 10.1186/1824-7288-37-52.
Whittemore R, Knafl K. The integrative review: updated methodology. Journal of advanced nursing, Oxford. 2005; 52(5): 546-53. Available from: doi: 10.1111/j.1365-2648.2005.03621.x
Ursi SE, GalvÃ£o, CM. Perioperative prevention of skin injury: an integrative literature review. Rev. Latino-Am. Enfermagem, RibeirÃ£o Preto Jan Feb 2006; 14(10: 124-31. Available from: <http://www.scielo.br/pdf/rlae/v14n1/v14n1a17.pdf> doi: http://dx.doi.org/10.1590/S0104-11692006000100017
El Dib RP. How to practice evidenceâ€“based medicine. J Vasc Bras, Porto Alegre. 2007; 6(1): 1-4. Available from: Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492007000100001&lng=en>. Doi: http://dx.doi.org/10.1590/S1677-54492007000100001.
Galvao CM, Sawada NO, Mendes IAC. In search of the best evidence. Rev Esc Enferm USP. 2003; 37(4): 43-50. Available from: <http://www.scielo.br/pdf/reeusp/v37n4/05.pdf> http://dx.doi.org/10.1590/S0080-62342003000400005
Wagner MB. Aspectos bÃ¡sicos da medicina embasada em evidÃªncias. Jornal de pediatria 1998; 74(5): 419-22. Available from: <https://www.lume.ufrgs.br/bitstream/handle/10183/56212/000437473.pdf?sequence=1>.
Correa FF, Vieira MC, Yamamoto DR, SperidiÃ£o PGL, Morais MB. Open challenge for the diagnosis of cow's milk protein allergy. J. pediatr. 2010; 86(2): 163-66. Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572010000200015>. doi.org/10.2223/JPED.1967.
Lins MGM, Horowitz MR, Silva GAP, Motta MEFA. Oral food challenge test to confirm the diagnosis of cowâ€™s milk allergy. J Pediatr. 2010; 86(4): 285-89. Available from: <http://www.scielo.br/scielo.php?pid=S002175572010000400007&script=sci_arttext>. doi: http://dx.doi.org/10.1590/S0021-75572010000400007.
Sommanus S, Kerddonfak S, Kamchaisatian W, Vilaiyuk S, Sasisakulporn C, Teawsomboonkit W et al. Cowâ€™s milk protein allergy: immunological response in children with cowâ€™s milk protein tolerance. Asian Pacific Journal of Allergy and Immunology. 2013; 32(3): 171-77. Available from: <http://apjai.digitaljournals.org/index.php/apjai/article/viewFile/1019/1147>. doi: 10.12932/AP0322.214.171.1243.
Alessandri C, Sforza S, Palazzo P, Lambertini F, Paolella S, Zennaro D, et al. Tolerability of a fully maturated cheese in cowâ€™s milk allergic children: biochemical, immunochemical, and clinical aspects. PlosOne. 2012; 7(7): 409-45. Available from: <http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040945>. doi: 10.1371/journal.pone.0040945.
Epifanio M, Spolidoro JV, Missima NG, Soder RB; Garcia PCR, Baldisserotto M. Cowâ€™s milk allergy: color Doppler ultrasound findings in infants with hematochezia. J Pediatr. 2013 nov-dec; 89(2): 554-8. Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572013000600007>. doi: http://dx.doi.org/10.1016/j.jped.2013.03.021
Kattan JD, Cocco RR, JÃ¤rvinen KM. Milk and soy allergy. Pediatric Clinics of North America. 2011; 58(2): 407-26. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070118/>. doi: 10.1016/j.pcl.2011.02.005.
Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. Journal of pediatric gastroenterology and nutrition. 2012; 55(2): 221-29. Available from: <http://www.ncbi.nlm.nih.gov/pubmed/22569527>. doi: 10.1097/MPG.0b013e31825c9482.
Madsen CB, Hattersley S, Buck J, Gendel SM, Houben GF, Hourihane JOâ€™B, et al. Approaches to risk assessment in food allergy: report from a workshop ''developing a framework for assessing the risk from allergenic foods. Food Chem Toxicol. 2009; 47(2):480-89. Available from: <http://www.sciencedirect.com/science/article/pii/S0278691508006765>. doi: 101016/jfct 2008.12.001.
Spanjersberg MQ, Knulst AC, Kruizinga AG, Van Duijn G, Houben GF. Concentrations of undeclared allergens in food products can reach levels that are relevant for public health. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2010; 27(2): 169-74. Available from: <http://www.tandfonline.com/doi/abs/10.1080/19440040903317513?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&>. doi: 10.1080/19440040903317513.
Kim JS, Nowak-WÄ™grzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cowâ€™s milk allergy in children. Journal of Allergy and Clinical Immunology. 2011; 128(1): 125-31. Available from: <http://www.sciencedirect.com/science/article/pii/S0091674911006749>. doi: 10.1016/j.jaci.2011.04.036.
Yonamine GH, Contim D, Castro APBM, Jacob CMA, Pastorine AC. Perceptions of caregivers of patients with cowâ€™s milk allergy regarding the treatment. Journal of Human Growth and Development. 2013; 23(1): 58-64. Available from: <http://pepsic.bvsalud.org/pdf/rbcdh/v23n1/pt_09.pdf>
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).