OBJECTIVE: There are few established diagnostic tools to define non-IgE-mediated food hypersensitivity reactions. Cow milk protein allergy (CMPA) is a multisystem disorder affecting the gastrointestinal, skin, and lower and upper airway systems. This link is frequently missed because of subspecialty evaluation of the multisystem effects individually. The authors hypothesize that a more global evaluation based on a simple scored questionnaire will reveal this link. METHODS: Over an 18-month period, children younger than 2 years with non-IgE-mediated CMPA were identified. A symptom questionnaire was developed and scored and also applied to a control population. The prevalence of symptoms in each group was compared and a cumulative score was determined. Symptoms evaluated included gastrointestinal, aerodigestive, lower airway, and skin symptoms. A positive response was scored 1 and a negative response scored 0. RESULTS: Significant differences in prevalence rates between CMPA and control populations were noted, particularly in aerodigestive symptoms. There were marked differences in cumulative score between populations (P < .001). The authors identified a cut-off score at which there was close to 80% sensitivity and 90% specificity for distinguishing CMPA from a control population. CONCLUSION: A global evaluation of multiple systems can be an important diagnostic tool in determining CMPA in infants.
OBJECTIVE: There are few established diagnostic tools to define non-IgE-mediated food hypersensitivity reactions. Cowmilk protein allergy (CMPA) is a multisystem disorder affecting the gastrointestinal, skin, and lower and upper airway systems. This link is frequently missed because of subspecialty evaluation of the multisystem effects individually. The authors hypothesize that a more global evaluation based on a simple scored questionnaire will reveal this link. METHODS: Over an 18-month period, children younger than 2 years with non-IgE-mediated CMPA were identified. A symptom questionnaire was developed and scored and also applied to a control population. The prevalence of symptoms in each group was compared and a cumulative score was determined. Symptoms evaluated included gastrointestinal, aerodigestive, lower airway, and skin symptoms. A positive response was scored 1 and a negative response scored 0. RESULTS: Significant differences in prevalence rates between CMPA and control populations were noted, particularly in aerodigestive symptoms. There were marked differences in cumulative score between populations (P < .001). The authors identified a cut-off score at which there was close to 80% sensitivity and 90% specificity for distinguishing CMPA from a control population. CONCLUSION: A global evaluation of multiple systems can be an important diagnostic tool in determining CMPA in infants.
Authors: Adam T Fox; Harm Wopereis; Marleen T J Van Ampting; Manon M Oude Nijhuis; Assad M Butt; Diego G Peroni; Yvan Vandenplas; David C A Candy; Neil Shah; Christina E West; Johan Garssen; Lucien F Harthoorn; Jan Knol; Louise J Michaelis Journal: Clin Transl Allergy Date: 2019-01-15 Impact factor: 5.871