2024/12/31 by Siala, N., Azzabi O, Dridi Y +7
#Allergy #FOS: Clinical medicine #allergie #child #cow’s milk #enfant #facteurs risque #food challengetest #lait de vache #riskfactors #test de provocation
paper · doi:10.71566/pist-rmp-194844
Background : Theoutcomeofcow’smilkal- lergy(CMA)usuallyprogressestoacquisitionof tolerance by three years of age, allowing a normal diet. This tolerance is tested by the oral challengetest(OCT)whichisnotwithoutrisk. The aim of this study was to describe the proce- dureofthereintroductionofcow’smilk(CM) in our population, to analyze its results and to identify the risk factors of failure of the reintro- duction. Methods:Weperformedaretrospectivestudy of 61 children followed in the paediatric depart- mentofMongiSlimhospitalforIgE-mediated CMA and whohada reintroductionof theCM duringtheperiodbetween2005and2016. Resulats:ThediagnosisofCMAwasmadeat the mean age of 4 months. On the follow-up, 31 patients developed tolerance to baked milk at a meanageof38months. TheOCTwasperfor- medinhospitalin26cases(43%)atamedian age of 25 months, failed in 46%. Cow’s milk was reintroduced at home in 35 cases (57%) at a me- dian age of 30 months, failed in 20%. Digestive symptoms (p=0. 029), allergic asthma (p=0. 044), drugallergy(p=0. 033),non-compliancetodie- tary avoidance (p=0. 04) and taking specific for- mula for a long period (p=0. 037) were signifi-cantlyassociatedwithfailureofreintroductionof CM. A significant difference in the skin prick-test(SPT) wealsize(p=0. 007)and thelastlevels of cow’s milk IgE (p=0. 012), ąlactalbumin IgE (p=0. 042) and ßlactoglobulin IgE (p=0. 026) was found in patients who had successfully reintro- ducedtheCMandthosewhosereintroduction had failed. Increased SPT weal size during the follow-up (p=0. 014) and a last cow’s milk IgE le-vel over than 2 KU/l (p=0. 019) were identified in the multivariate analysis as a major risk factor independently associated to failure of reintro- duction of CM. Conclusion : The OCT is the only tool to confirm the acquisition of tolerance to cow’s milk in caseof CMA. The appropriateness and timing of reintroduction should be assessed based on the results of SPT and specific IgE antibodies. In- creased SPT weal size during the follow-up and elevated level of cow’s milk sIgE may predict the failure of reintroduction.