European Journal of Pediatrics

, Volume 172, Issue 3, pp 385–391

Towards better triage of infants suspected of cow's milk allergy: development of a preliminary multivariable diagnostic index

Authors

    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Anne-Fleur Schoemaker
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Stef Menting
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Jennifer van Dulmen
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Janne Boeting
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Wim van Aalderen
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
  • Gerben ter Riet
    • Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical CenterUniversity of Amsterdam
  • Aline Sprikkelman
    • Department of Paediatric Respiratory Medicine and AllergyEmma Children’s Hospital
Original Article

DOI: 10.1007/s00431-012-1900-8

Cite this article as:
van Thuijl, A., Schoemaker, A., Menting, S. et al. Eur J Pediatr (2013) 172: 385. doi:10.1007/s00431-012-1900-8

Abstract

The double-blind placebo-controlled food challenge (DBPCFC) is currently the gold standard to diagnose cow's milk allergy (CMA). However, DBPCFCs are burdensome, expensive and require specialised facilities. For primary care physicians, selective and consistent referral to DBPCFC of infants suspected of CMA may be difficult. The objective of this study was to assess the predictive value of clinical parameters for a positive DBPCFC in infants suspected of CMA. Clinical data from 124 infants suspected of CMA that had undergone a DBPCFC were collected. Out of a total of 23 parameters, nine candidate predictors were selected on clinical grounds. We used bootstrapped logistic regression analysis to find a more parsimonious and practical model. The prevalence of a positive DBPCFC was 34.7 % (95 % CI from 27 to 43). A well-calibrated diagnostic model containing as predictors abdominal cramps, inconsolable crying and the objective SCORAD index discriminated moderately well between infants with and without a positive DBPCFC. The area under the ROC curve was 0.68 (95 % CI from 0.58 to 0.78). The fifth and 95th percentiles of the positive DBPCFC predictive probability distribution were 17 and 73 % (17 and 59 % after correction for over-optimism). We conclude that a diagnostic model with three clinical parameters may be used for better referral of children suspected of CMA and the decision to either initially perform an open food challenge or directly perform a DBPCFC. Large prospective studies are needed to validate these findings and provide additional precision.

Keywords

Cow's milk allergy Infants Diagnosis Logistic regression Retrospective cohort study

Abbreviations

BIF

Bootstrap inclusion fraction

CMA

Cow's milk allergy

CMP

Cow's milk protein

DBPCFC

Double-blind placebo-controlled food challenge

SCORAD

SCORing atopic dermatitis

IQR

Interquartile range

Copyright information

© Springer-Verlag Berlin Heidelberg 2012