Single dose oral challenges in children with cow's milk alle
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The approximate ED05 values for cow's milk range from 0.5mg to 13.9mg of cow's milk protein (the dose predicted to cause objective allergic symptoms in 5 percent of the milk-allergic population). The use of eliciting doses (ED) to warn allergen risk management is of growing interest. The ED can be calculated from the distribution of threshold doses within a given population for allergic subjects experiencing food challenges. To confirm a projected ED05 for cow's milk of 0.5mg protein, researchers undertook a single-dose challenge analysis.

Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5mg cow’s milk protein (approximately 0.015ml of fresh cow’s milk). Children over 1 year underwent formal challenge to cow’s milk to confirm clinical reactivity. 172 children (median age 6.0 (IQR 0.7-11) years, 57% male) were included in this analysis.

Results:
-- 12 children experienced objective symptoms that met the predetermined criteria.

--1 participant had mild anaphylaxis which responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required.

--Any baseline predictors of sensitisation which were associated with objective reactivity to the single-dose challenge using 0.5mg cow’s milk protein were not identified.

In particular, these data support the estimated ED05 of 0.5 mg protein for cow's milk, but it is necessary to review the ED05 values above 0.5 mg for cow's milk protein suggested for allergen risk management.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/pai.13482?af=R
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