Remaining symptoms in half the children treated for milk allergy

• Published in: European journal of pediatrics Vol. 174; no. 6; pp. 759 - 765
• Main Authors: Petrus, Nicole C. M., Schoemaker, Anne-Fleur A., van Hoek, Meike W., Jansen, Laura, Jansen-van der Weide, Marijke C., van Aalderen, Wim M. C., Sprikkelman, Aline B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2015; Springer Nature B.V
• Subjects: Amino acids; Child; Child, Preschool; Children & youth; Cohort analysis; Double-Blind Method; Female; Food allergies; Humans; Hydrolysis; Logistic Models; Male; Medicine; Medicine & Public Health; Milk Hypersensitivity - physiopathology; Milk Hypersensitivity - therapy; Original Article; Parental rights; Pediatrics; Treatment Failure; Variables; Whey; Amino acid-based formula; Treatment; Extensively hydrolyzed whey formula; Cow’s milk allergy
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-014-2456-6

The aim of this study was to investigate the cumulative incidence and predictive variables of treatment failure with a whey-based extensively hydrolyzed formula (w-eHF) in children with cow’s milk allergy (CMA). All children were diagnosed with CMA, using double-blind placebo-controlled food challenge (DBPCFC) with amino acid-based formula as placebo, and receive w-eHF treatment after diagnosis. Forty-nine children with CMA were included. w-eHF treatment failure was defined as incomplete resolution of original CMA symptoms upon w-eHF treatment and disappearance of these symptoms upon replacement of w-eHF with amino acid-based formula. A multiple logistic regression model was used to investigate which variables could predict treatment failure. Twenty-five (51 %; 95 % confidence interval (CI) 38–64 %) of the children with CMA failed on w-eHF. Only “gastrointestinal discomfort” was found to contribute independently to the probability of failing w-eHF, odds ratio (95 % CI) 8.994 (1.007–79.457). Conclusions : In half of the children with proven CMA, there is incomplete resolution of symptoms upon w-eHF treatment. This study needs to be repeated including DBPCFC with w-eHF to provide more definitive diagnosis, especially since gastrointestinal discomfort seems to be the sole predictive variable for treatment failure. In the meantime, a change in formula should be considered in children with incomplete symptom resolution upon w-eHF treatment.