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Published in: European Journal of Pediatrics 3/2013

01-03-2013 | Original Article

Towards better triage of infants suspected of cow's milk allergy: development of a preliminary multivariable diagnostic index

Authors: Anders van Thuijl, Anne-Fleur Schoemaker, Stef Menting, Jennifer van Dulmen, Janne Boeting, Wim van Aalderen, Gerben ter Riet, Aline Sprikkelman

Published in: European Journal of Pediatrics | Issue 3/2013

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Abstract

The double-blind placebo-controlled food challenge (DBPCFC) is currently the gold standard to diagnose cow's milk allergy (CMA). However, DBPCFCs are burdensome, expensive and require specialised facilities. For primary care physicians, selective and consistent referral to DBPCFC of infants suspected of CMA may be difficult. The objective of this study was to assess the predictive value of clinical parameters for a positive DBPCFC in infants suspected of CMA. Clinical data from 124 infants suspected of CMA that had undergone a DBPCFC were collected. Out of a total of 23 parameters, nine candidate predictors were selected on clinical grounds. We used bootstrapped logistic regression analysis to find a more parsimonious and practical model. The prevalence of a positive DBPCFC was 34.7 % (95 % CI from 27 to 43). A well-calibrated diagnostic model containing as predictors abdominal cramps, inconsolable crying and the objective SCORAD index discriminated moderately well between infants with and without a positive DBPCFC. The area under the ROC curve was 0.68 (95 % CI from 0.58 to 0.78). The fifth and 95th percentiles of the positive DBPCFC predictive probability distribution were 17 and 73 % (17 and 59 % after correction for over-optimism). We conclude that a diagnostic model with three clinical parameters may be used for better referral of children suspected of CMA and the decision to either initially perform an open food challenge or directly perform a DBPCFC. Large prospective studies are needed to validate these findings and provide additional precision.
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Metadata
Title
Towards better triage of infants suspected of cow's milk allergy: development of a preliminary multivariable diagnostic index
Authors
Anders van Thuijl
Anne-Fleur Schoemaker
Stef Menting
Jennifer van Dulmen
Janne Boeting
Wim van Aalderen
Gerben ter Riet
Aline Sprikkelman
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Journal of Pediatrics / Issue 3/2013
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-012-1900-8

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