To characterise the cases of cow’s milk protein allergy (CMPA) followed in our GI Outpatient Clinic and determine how much parents save on extensively hydrolyzed milk (EHM) when oral food challenge (OFC) is performed <12 months (M).
CMPA patients observed between October2010-October2013 were included in this retrospective study based on Service’s CMPA protocol: OFC >6 M, except at parents’ request. Calculations: each package of EHM costs 20€ and has 102 doses and of infant formula (IF) costs 10€ and has 181 doses, according to each infant’s nutritional needs. Statistical analysis: Mann-Whitney test.
Sixty-four children were included; 59% females. The median age of onset was 3 M (0.43–12 M). Most frequent symptoms were cutaneous (n = 37) and gastrointestinal (n = 27). IF was the main dairy product that triggered symptoms (64%;22% with hypoallergenic formula). Family history of atopy was positive in 63%;54% had atopic disease, namely atopic dermatitis (82%). Measurement of cow’s milk-specific IgE was performed in 33;24 with positive results. Fifteen of 20 children with information about the use of IF in maternity had the first dose of CMP at that time. The first OFC was positive in 45%, and was performed at a median age of 10 M (3–39 M). Forty children had their OFC <12 M and in most cases (n = 25) it was negative. Performing the OFC <12 M, each infant with a negative result spared 326€ on EHM. Tolerance was achieved at a median age of 12 M (3–84 M). Children with bloody diarrhoea acquired tolerance earlier, median age 8 M (5–23 M), than the group with cutaneous symptoms, median age 14 M (4–84 M), p = 0.005.
It’s safe and beneficial, both for children and parents, to perform OFC from 6 to 12 M.