title: Remaining symptoms in half the children treated for milk allergy.
abstract: The aim of this study was to investigate the cumulative incidence and predictive variables of treatment failure with a whey-based extensively hydrolyzed formula (w-eHF) in children with cow's milk allergy (CMA). All children were diagnosed with CMA, using double-blind placebo-controlled food challenge (DBPCFC) with amino acid-based formula as placebo, and receive w-eHF treatment after diagnosis. Forty-nine children with CMA were included. w-eHF treatment failure was defined as incomplete resolution of original CMA symptoms upon w-eHF treatment and disappearance of these symptoms upon replacement of w-eHF with amino acid-based formula. A multiple logistic regression model was used to investigate which variables could predict treatment failure. Twenty-five (51%; 95% confidence interval (CI) 38-64%) of the children with CMA failed on w-eHF. Only "gastrointestinal discomfort" was found to contribute independently to the probability of failing w-eHF, odds ratio (95% CI) 8.994 (1.007-79.457).
  
  
  CONCLUSIONS
  In half of the children with proven CMA, there is incomplete resolution of symptoms upon w-eHF treatment. This study needs to be repeated including DBPCFC with w-eHF to provide more definitive diagnosis, especially since gastrointestinal discomfort seems to be the sole predictive variable for treatment failure. In the meantime, a change in formula should be considered in children with incomplete symptom resolution upon w-eHF treatment.
authors.affiliation: Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, n.c.petrus@amc.nl.
authors.forename: Nicole C M
authors.initials: NC
authors.lastname: Petrus
authors.forename: Anne-Fleur A
authors.initials: AF
authors.lastname: Schoemaker
authors.forename: Meike W
authors.initials: MW
authors.lastname: van Hoek
authors.forename: Laura
authors.initials: L
authors.lastname: Jansen
authors.forename: Marijke C
authors.initials: MC
authors.lastname: Jansen-van der Weide
authors.forename: Wim M C
authors.initials: WM
authors.lastname: van Aalderen
authors.forename: Aline B
authors.initials: AB
authors.lastname: Sprikkelman
mesh_terms: D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006868:Hydrolysis; D016015:Logistic Models; D008297:Male; D016269:Milk Hypersensitivity / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure; D000067796:Whey