Fractional exhaled nitric oxide in infants during cow's milk food challenge

Carmelo Gabriele, Jeroen Hol, Evelien Kerkhof, Beatrix E E Elink Schuurman, Janneke N Samsom, Wim Hop, EES Nieuwenhuis, Johan C de Jongste

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Cow's milk allergy (CMA) is the most common food allergy in early childhood. The golden standard for the diagnosis of CMA is a food challenge after a period of elimination. Increased levels of fractional exhaled nitric oxide (FE(NO)) have been shown after bronchial allergen provocation. We evaluated whether FE(NO) may also be a predictor of a positive reaction during cow's milk challenge in infants. Forty-four infants [mean age (range): 4.2 (3.7-4.6) months] suspected of CMA underwent an open food challenge with cow's milk formula administered in ascending quantities, starting with 2 ml and then 6, 20, 60 and 200 ml until a clinical reaction occurred. Off-line FE(NO) samples were obtained during tidal breathing by means of a facemask covering infants' nose and mouth. FE(NO) was measured twice before the challenge (baseline), immediately before each new dose of milk and after a positive reaction or after the last dose of milk. Eleven children showed immediate positive clinical responses to cow's milk, whereas 13 infants presented only a late-type reaction. FE(NO) values before or after a positive reaction (either immediate or late) were not different from FE(NO) values at baseline. Baseline FE(NO) in infants with a positive reaction did not differ from FE(NO) in infants without a reaction at any time point. We conclude that FE(NO) values are not predictive and not related to the occurrence of a positive reaction during a cow's milk challenge in infants, suggesting that a positive reaction may not result from eosinophilic activation.

Original languageEnglish
Pages (from-to)420-5
Number of pages6
JournalPediatric Allergy and Immunology
Volume19
Issue number5
DOIs
Publication statusPublished - Aug 2008

Keywords

  • Allergens
  • Animals
  • Bronchial Provocation Tests
  • Dose-Response Relationship, Immunologic
  • Exhalation
  • Female
  • Humans
  • Infant
  • Infant Formula
  • Male
  • Milk
  • Milk Hypersensitivity
  • Nitric Oxide
  • Predictive Value of Tests
  • Prognosis

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