Cow's milk protein allergy is a topical issue in pediatrics. The diagnostic algorithm for cow's milk protein allergy includes thorough history taking, examination, physical development assessment, determination of specific cow's milk IgE, and oral food challenge tests.
The study aimed to develop a step-by-step algorithm for conducting oral food challenge tests with milk in young children, taking into account individual indications and risks.
Materials and methods. The task is to diagnose the cow's milk protein allergy in children in the first year of life. It is solved by allergy history taking, examination, assessment of physical development, detection of specific cow's milk IgE and based on the obtained results, oral food challenge test is performed: in age category before reaching one year when the specific IgE is more than 0.7 kU/L, testing is performed in the intensive care unit, if the specific IgE is less than 0.7 kU/L – in a specialized inpatient department.
Patients. The algorithm for diagnosing cow's milk protein allergy in 96 children under 12 months of age was tested in the City Children's Clinical Hospital.
During the oral food challenge test, the dose is increased logarithmically until the desired amount of product is reached, depending on the predicted risk of the reaction. Children at medium risk (specific IgE less than 0.7 kU/L) are tested in a specialized inpatient department by “five steps”, and at high risk (specific IgE greater than 0.7 kU/L) – in the intensive care unit by “eight steps”.
Results. Among 96 children who underwent an oral food challenge test with milk, cow's milk protein allergy was diagnosed in 42 (43.75%). After the oral food challenge test, patients were given further recommendations, of which 27 (64.29%) were transferred to a formula with total protein hydrolysis, and 15 (35.71%) began to take oral tolerance induction (regular administration of acidified milk formula from lower doses to larger).
Conclusions: The developed algorithm for conducting oral food challenge tests with milk in children of the first year of life gives a possibility to personally select the examination technique taking into account the indications and risks. Appropriate preparation for the oral food challenge test enables to correctly conduct it, interpret the results, and develop a therapeutic approach.
Keywords: cow’s milk allergy, food allergy, oral food challenge test.