Assuming that you have read the articles about JESUS so far, I will ask you this: “How can you be sure if your baby really has JESUS?”
JESUS Unfortunately, the diagnosis cannot be made by doing 1-2 tests... We also observe the following to the families who come: "Thank God, the allergy is not high in their blood; Then we can say that he is not allergic, right doctor? But unfortunately things don't work that way... Because if you remember, we said that there are 2 types of immunological reactions in ISA:
For now, we can only test IgE and cow's milk specific IgE in the blood to detect the allergic condition. Therefore, just because IgE is not high does not mean that there is no allergy. There is no "definitive" test yet for late allergic reactions caused by the cellular pathway.
So how can a definitive diagnosis be made? This is where the doctor's clinical observation skills come into play; A diagnosis is made by asking some questions and synthesizing the answers received, taking into account the examination findings and the process the child is experiencing. Then, some tests are applied:
Blood Tests for Cow's Milk Allergy
Total immunoglobulin E and food-specific (medically known as antigen-specific) immunoglobulin E are checked in the blood. Such as milk IgE, fish IgE, egg white IgE, strawberry IgE... However, if the patient's allergic reaction is not IgE-mediated - even though the patient is allergic - neither the total IgE in the blood nor the cow's milk-specific IgE will be high.
We have seen the following in the patients we have followed over the years: In the initial tests (for example, at the age of 2-3 or 6 months), IgE and specific IgE tests were not high - even though the child was allergic - but when we repeated the test after a certain period of time (here, after 1-2 years). I'm talking about this, this is not a test that should be checked every 1-2 months) it may be elevated.
Just because IgE is not high in the patient does not mean that the patient is not allergic.
Food Elimination Test in Cow's Milk Allergy
Since our topic is ISA, we can explain elimination as follows: Everything containing milk and dairy products in the daily diet of the baby and the mother if she is breastfeeding. It is stopped and it is monitored whether the symptoms decrease or not. The duration of the trial by stopping the food is at least 2 weeks and at most 2-3 months. Consuming foods containing milk protein during this period will cause an error in the elimination test. The presence of additional food allergies in the patient makes the evaluation of the test difficult. (My patient's mother, Ms. K.Y., stopped everything when her second child had bleeding in the stool and monitored the baby's stool for 2-3 days after stopping each food. During this process, she started to eat almost only olives, tomatoes, cucumbers and 1-2 fruits, which caused the baby's digestive problems to be poor. system symptoms and bleeding in the stool improved. His mother discovered that the baby had a wheat allergy in addition to ISA.
Provocation test in Cow's Milk Allergy
This is another test used in the diagnosis of food allergies, especially ISA. As the name suggests, it is based on "provoking" the allergic reaction in the patient. But first, elimination should be applied to the patient, that is, it should be seen that the patient's symptoms regress after the diet. Then, it should be monitored whether the symptoms return when the patient is given foods containing milk protein.
Oral provocation test. The screening test begins by placing food on the lips beforehand.The food to be tested is placed on the lower lip for 2 minutes and local or systemic reactions are observed for the next 30 minutes. If the following reactions occur, the test result is considered positive, meaning that there is an allergy to that food.
Positive result criteria:
- Rash covering the chin and cheek
- Lip edema with conjunctivitis or rhinitis
- Systemic reaction
If these reactions do not occur, then continue with the oral provocation test.
What caused the food taken orally? Symptoms that may occur (ranging from itching on the lips, abdominal pain, cramps, vomiting, bloody diarrhea and swelling in the face and eyes) are monitored and emergency intervention is performed if necessary.
Source: Rance F, et al. Pediatr Allergy Immunol 1999;10:33-38
DBPCFC test: Double Blind Placebo Controlled Food Challenge
The source in this section is K.T.Ü. Faculty of Medicine Pediatric Allergy Department faculty member Assoc. Dr. Fazıl Orhan's presentation titled "Diagnosis in Food Allergies, Oral Challenge Tests" was used.
DBPCFC test stands for: Double Blind Placebo. It is the Controlled Food Challenge test. Turkish: Placebo-controlled, double-blind food challenge test... The term "double blind" here means that neither the patient nor the doctor knows whether the food given to the patient by the doctor at the time of the test is really allergen or placebo. So, who knows what is given to the patient? The technical team that prepared the test knows. For example, to determine whether a person has an egg allergy, let's say a person is given a mixture containing egg and a mixture without egg at different times. The technical team prepares two mixtures that are exactly the same in terms of taste and smell, numbers them (let the first mixture given at another time be called mixture number 1, and the other mixture given at another time is called mixture number 2) and the doctor gives it to them. Neither the doctor nor the patient know which food is which, they only know that it is a mixture of numbers 1 and 2. The doctor gives number 1 of these mixtures to the patient, the patient eats it and observes whether an allergic reaction occurs over time. Regardless of whether there is a reaction or not, after a while - which may be in the afternoon or the next day - the second food is fed to the patient. Again, it is observed whether there is a reaction.
The patient eats two allergenic and non-allergenic foods, but since he eats both at different times but does not know what the food he eats is, this test is called "placebo controlled".
DBPCFC test is especially useful in the presence of subjective symptoms that are doubtful whether they actually exist, such as tingling, numbness, rash and itching without redness.
This test must be performed under hospital conditions and, if necessary, by hospitalizing the patient and consulting an allergist.
Pre-test precautions
- DBPCFC test is performed on an empty stomach.
- Baseline systemic examination before DBPCFC - vital signs, respiratory function if the patient's age is appropriate. tests are performed.
- Open intravenous access: In high-risk DBPCFC, in the person with high specific IgE, vascular access is opened as a precaution for those who have previously had a severe reaction.
- The food to be tested before the test. -Stopped 14 days in advance
- Drugs that may disrupt the test are stopped: Antihistamines, beta-agonist, cromolyn, theophylline
Preparation of DBPCFC test material
- Placebo and food combination should not be distinguished from each other in any way
- Labeling is done with exactly the same material.
- Care is taken to avoid cross-contamination
- Dosage weight is the same
- Storage: Appearance, taste and smell must be exactly the same.
Means that can be used to hide the taste of food and placebo
- Capsules
- Formula foods
- Ice cream
- Apple puree
- Chocolate pudding
- Fruit mix
- Grape juice
- Hamburger
- Canned tuna
- Lentil soup
- Grain foods
- Mashed potatoes
Frequently used food + storage tools
- Milk (powder): Grape juice, formula
- Egg (powder) ): Grape juice, formula, milk
- Eggs (fresh, cooked): Pudding, mashed potatoes
- Peanuts ( roasted): Chocolate pudding, capsule
- Soy (flour): Applesauce, lentil soup, hamburger
- Wheat (flour) ): Apple puree, capsules, hamburgers
- Fish (raw, cooked): Canned tuna
- Hazelnuts-walnuts etc. nuts: Chocolate pudding
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