Exclusively breastfed infants at risk for false negative double blind placebo controlled milk challenge.
The double blind placebo controlled food challenge (DBPCFC) is the gold standard for diagnosing cow's milk allergy (CMA). However, false-negative DBPCFC have been reported. We present 2 cases with a false negative DBPCFC in exclusively breastfed infants suspected of CMA. These cases highlight the occurrence of severe allergic reactions of infants who were exclusively breastfed. Several reported causes of a false negative DBPCFC will be discussed. However, there is currently no clear understanding of the cause of a false negative DBPCFC. This paper highlights that a negative outcome of a DBFCFC must be interpreted with caution, because a severe allergic reaction might occur upon re-introduction of cow's milk. Therefore, an additional open food challenge under medical supervision is recommended in exclusively breastfed infants with a negative DBPCFC.
Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands. n.c.petrus@amc.nl.
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Petrus
Nutricia Advanced Medical Nutrition Division, Schiphol, The Netherlands.
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EA
Kole
Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
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Schoemaker
Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
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WM
van Aalderen
Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
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Sprikkelman
D001942:Breast Feeding; D004311:Double-Blind Method; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis*; D010919:Placebos; D012306:Risk
D010919:Placebos
Cow’s milk allergy; double-blind placebo controlled food challenge; false negative; infants; open food challenge