title: Cow's milk-associated gastrointestinal symptoms evaluated using the double-blind, placebo-controlled food challenge.
abstract: OBJECTIVE
  The aim of this study was to evaluate the suspicion of cow's-milk allergy in infants with unspecific gastrointestinal (GI) symptoms using the double-blind, placebo-controlled food challenge.
  
  
  METHODS
  A prospective cohort study, which recruited 57 consecutive children with gastrointestinally manifested symptoms suspected of cow's-milk allergy. All patients underwent a 5-day double-blind, placebo-controlled food challenge for cow's milk.
  
  
  RESULTS
  The median age of the patients was 8.7 months. None had measurable cow's-milk-specific IgE. The food challenge was positive in 18 (32%) cases, with symptoms manifesting within 48 hours in 17 of 18 cases. The only symptom that correlated with the positive challenge was loose stools, reported as a presenting symptom in 78% of challenge-positive and in 46% of challenge-negative children (P = 0.043). During active challenge, the respective proportions were 82% and 2% (P < 0.0001). No serious adverse effects were manifested during the challenges. In the challenge-negative group, significant placebo reactions occurred in 18 (46%) patients. In the challenge-negative children, adult-type hypolactasia genotype CC frequency was higher (31%, P = 0.033) than national prevalence of 18%.
  
  
  CONCLUSIONS
  In an infant with unspecific GI symptoms suspected of cow's-milk allergy, this diagnosis is seldom confirmed. Other reasons for the troublesome GI symptoms should also be identified.
authors: Division of Pediatric Gastroenterology, Children's Hospital, Helsinki, Finland. laura.merras-salmio@hus.fi
authors: Laura
authors: L
authors: Merras-Salmio
authors: Anna S
authors: AS
authors: Pelkonen
authors: Kaija-Leena
authors: KL
authors: Kolho
authors: Mikael
authors: M
authors: Kuitunen
authors: Mika J
authors: MJ
authors: Mäkelä
mesh_terms: D000818:Animals; D002417:Cattle; D002675:Child, Preschool; D003672:Defecation; D004032:Diet / Q000009:adverse effects*; D004311:Double-Blind Method; D005243:Feces; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood / Q000209:etiology* / Q000235:genetics; D005838:Genotype; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D043322:Lactase / Q000172:deficiency / Q000235:genetics; D007787:Lactose Intolerance / Q000150:complications / Q000235:genetics; D008297:Male; D008892:Milk / Q000009:adverse effects* / Q000276:immunology; D016269:Milk Hypersensitivity / Q000097:blood / Q000150:complications; D015990:Placebo Effect; D011446:Prospective Studies
chemical_list: D007073:Immunoglobulin E; D043322:Lactase