Elimination and provocation test in cow's milk hypersensitive children

Background Allergic disease in infancy mostly related to cow's milk allergy. The prevalence of cow's milk hypersenstivity in chil- dren has increased steadily in the past years; therefore diagnostic accuracy is important and every symptomatic child with positive specific lgE should be followed by elimination and provocation. Objective To diagnose cow's milk hypersensitivity on children un- der three years old using elimination and provocation methods. Methods This was a clinical diagnosis study, in which children with allergy symptoms were examined for cow's milk sensitivity using prick test or lgE Radioallergosorbent test (RAST). Those with positive results underwent an elimination for minimal of 2 weeks and were challenged aterwards. The study was a qualitative diagnostic test with the gold standard of recurrence of symptoms after challenge test. Results There were forty subjects included in the challenge pro- cess with mean age of 17 months old. Boys and girls were equally distributed. There were 6 7% subjects with positive results on challenge with positive prick test and 64% positive challenge with history of positive lgE RAST. Sixty-five percents of subjects with positive results on challenge had more than 2 weeks elimination period. There was no statistical significance found in children with positive results on challenge, using neither prick test or lgE RAST. Conclusions Cow's milk protein allergy can be diagnosed on chil- dren less than 3 years old by applying elimination and challenge procedure. lgE sensitivity alone can not determine hypersensitivit