Safety and Effectiveness of Oral Food Challenge in Children with Cow's Milk Allergy: Clinical Experience from a Brazilian Reference Center
Monday, March 5, 2018
South Hall A2 (Convention Center)
Ana Laura Mendes Becker Andrade, MD, Príscila da Silva Pereira, MD, Carla de Oliveira Parra Duarte, MD, Atila Lima da Silva, MD, Maria Marluce Dos Santos Vilela, MD, PhD, Marcos Tadeu Nolasco da Silva, MD, PhD, Maria Angela Bellomo Brandão, MD, PhD, Adriana Gut Lopes Riccetto, MD, PhD
RATIONALE: Oral Food Challenge (OFC) is the gold standard for the diagnosis of cow's milk allergy (CMA). As some Brazilian public services provide special infant formulas, the diagnostic accuracy and proper management of CMA are relevant for public health expenditures. We aimed to determine the profile of children with CMA submitted to OFC at a university hospital and evaluate its public health impact.

METHODS: Analysis of 52 children with CMA, submitted to 58 open-OFC for fresh or baked milk. Data were obtained from standardized records and complemented from retrospective chart review.

RESULTS: 59.62% boys. Age at test: 53.85% <3 years. Onset of symptoms: <1 year in 94.23%. Symptoms related to CMA: gastrointestinal (48.08%), cutaneous (11.54%), two or more (40.38%). 21.15% had anaphylaxis. Feeding at the onset of symptoms: milk-based formula (40.39%), milk-based formula and breast milk (25.0%), breast milk (13.46%), whole milk or derivatives (21.15%). In the elimination diet, 43 patients used extensively hydrolyzed, amino acid–derived or soy formulas. Of the OFCs performed, 72.41% were negative and 27.59% positive. Three patients had anaphylaxis, receiving treatment, with symptom control. From 28 patients who were still receiving special formulas at the time of the test, the negative OFC allowed their suspension and the release of regular milk-based formula/ whole milk to 16 of them. This result led to savings of approximately 35,500 dollars/year.

CONCLUSIONS: Performing OFC in children with CMA led to reduced costs to the public health service, by reducing the indiscriminate use of special formulas. The test proved to be safe and effective.