The Clinical Study Of Cow’s Milk Allergy Diagnosis By Cow’s Milk Challenge Test

Objectives: Through cow’s milk challenge test, the clinical manifestations of cow’s milk allergy(CMA)could be generally understood, the diagnostic value of cow’s milk challenge test on cow’s milk allergy could be valued, and comparison between clinical assistant examinations and the results of cow’s milk challenge test could be made.Methods:An analysis was performed on the clinical manifestations and the challenge results of 57 infants who suspected cow’s milk allergy received cow’s milk challenges after admission to the Department of Digestive, Dermatology and Respiration,C hildren’s Hospital of Soochow University from February,2015 to November,2015. Among them, there were 30 males and 27 females,The youngest subject was 1 months old,and the oldest was 20 months most,94 percent children were younger than 12 months. And compared the blood changes of cow’s milk challenges positive group and negative group, At the same time comparing blood changes within each group before and after food challenge. Analysis of serum total IgE antibody, serum milk protein specific IgE and IgG and the relationship between the results of the cow’s milk challengeResults:(1) In 57 cases of suspected cow’s milk protein allergy, 53 cases(92.9 %) of digestive tract symptoms,2 cases(3.5%)of respiratory symptoms,4 cases(7.0%) of skin symptoms. 7 cases(12.2%) of systemic symptoms, and 9 cases(15.7%) of mixed symptom. Systemic symptoms included body weight does not increase in 3 patients(5?.2%) and crying in 4 patients(7.0%),The symptoms of 53 cases(92.9%) children can be improved within a week after elimination die.(2) 57 cases of children with challenges induced positive 23 cases(40.4%),and negative 34 cases(59.6%), Contrast negative and positive group,Both them were have respiratory tract, digestive tract, skin and systemic symptoms. and with mixed multi system symptoms, the digestive tract as the main clinical manifestations. But there was no significant difference. The symptoms of digestive tract in positive group and negative group were respectively 31 cases(91%), 22 cases(95%). One of the most common manifestation is hematochezia. Family history of allergic or allergic reactions in children is a high risk factor for milk protein allergy. and there was no significant difference between negative and positive group.The manifestation of challenges test include stimulate hematochezia, rash, vomiting, diarrhea, mucous stool and crying.but atopic dermatitis( 74%) and hematochezia(13%) were the main manifestations. Among them,22 cases of delayed reaction, only 1 cases of immediate reaction.(3) The change of 49 cases blood routine in the count of blood cell,neutrophil ratio,eosinophils ratio and platelet was studied,however.there were no statistical difierenees between the challenge failed children and the passed ones.It is interesting that the neutrophil ratio was higher which have statistical difierenees after challenge among children who passed the challenge,but the change in the count of blood cell,eosinophils ratio and platelet were no statistical difierenee s.(4) The positive rates of serum total IgE, specific milk protein IgE and IgG positive rate were 4.5%、13.6% and77.2% respectively in the positive group of 22 cases.and the positive rates of serum total IgE, specific milk protein IgE and IgG positive rates were 3.7%、3.7%、62.9%, respectively in the negative group of 27 patients.But compare with the challenge positive group and negative group, there was no significant difference in serum cow’s milk protein IgE and IgG.Conclusion:(1)Cow’s milk protein allergy often involves the respiratory tract, digestive tract and skin. And the symptom diversity, lack of specificity,SO the diagnosis is difficult.(2)cow ’s milk challenge test is the gold standard of diagnosis cow’s milk protein allergy,is the gold standard,and the result of challenges test is hematochezia and atopic dermatitis were the main manifestations.(3)The increase of neutrophil ratio can be used as one of the basis for judging the result of challenge test(4)The clinical significance of the detection of total serum IgE and serum milk protein IgE in infants with suspected milk protein allergy is not significant. Testing for IgG against cow’s milk is not recommended as a diagnostic tool. It is important and necessary to perform cow’s milk protein challenge.