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Remaining symptoms in half the children treated for milk allergy

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Abstract

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.

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Abbreviations

AAF:

Amino acid-based formula

AUC:

Area under the curve

c-eHF:

Casein-based extensively hydrolyzed formula

CMA:

Cow’s milk allergy

CMP:

Cow’s milk protein

DBPCFC:

Double-blind placebo-controlled food challenge

e-HF:

Extensively hydrolyzed formula

EuroPrevall BCS:

EuroPrevall Birth Cohort Study

FC:

Food challenge

sIgE:

Specific immunoglobulin E

SPT:

Skin prick test

w-eHF:

Whey-based extensively hydrolyzed formula

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Acknowledgment

The authors would like to thank all children and their parents for participating in the Dutch EuroPrevall Birth Cohort Study. We thank the nurses of the Emma Children’s Hospital department for day care for their support in performing the food challenges and the employees of the special kitchen for preparing all the challenges. Furthermore, we would like to thank Dr. JH van der Lee, I de Vreede, N Rutjes, and L Hulshof for their valuable scientific input.

Funding source

The EuroPrevall study is funded by the European Commission (FOOD-CT_2005-514000). The Dutch cohort received unrestricted grants from Nutricia, the Netherlands, Nutricia Advanced Medical Nutrition, the Netherlands, AstraZeneca, the Netherlands, TEVA, the Netherlands, and GlaxoSmithKline, the Netherlands. These companies were not involved in the design of the study or collecting the data.

Conflict of interest

Aline B Sprikkelman received speaker’s fees from Nutricia Advanced Medical Nutrition, The Netherlands, and Mead Johnson, The Netherlands, and research grants from Danone Research, The Netherlands. All other authors declare no potential conflict of interest.

Ethical statement

The Medical Ethics Committee of the Academic Medical Hospital (METC 06/005) approved the Dutch EuroPrevall BCS. Written informed consent was obtained from both parents of each child, unless only one of them had parental rights.

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Authors and Affiliations

  1. Department of Paediatric Respiratory Medicine and Allergy, Emma Children’s Hospital AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Nicole C. M. Petrus, Anne-Fleur A. Schoemaker, Meike W. van Hoek, Laura Jansen, Wim M. C. van Aalderen & Aline B. Sprikkelman

  2. Clinical Research Unit Woman-Child Center, Emma Children’s Hospital AMC, Amsterdam, The Netherlands

    Marijke C. Jansen-van der Weide

Authors
  1. Nicole C. M. Petrus
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  2. Anne-Fleur A. Schoemaker
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  3. Meike W. van Hoek
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  4. Laura Jansen
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  5. Marijke C. Jansen-van der Weide
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  6. Wim M. C. van Aalderen
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  7. Aline B. Sprikkelman
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Corresponding author

Correspondence to Nicole C. M. Petrus.

Additional information

Communicated by David Nadal

Nicole C. M. Petrus and Anne-Fleur A. Schoemaker contributed equally.

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Petrus, N.C.M., Schoemaker, AF.A., van Hoek, M.W. et al. Remaining symptoms in half the children treated for milk allergy. Eur J Pediatr 174, 759–765 (2015). https://doi.org/10.1007/s00431-014-2456-6

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  • DOI: https://doi.org/10.1007/s00431-014-2456-6

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