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- Trial-and-error method: 94% of children with food allergies were diagnosed with a false diagnosis
Trial-and-error method: 94% of children with food allergies were diagnosed with a false diagnosis
Scientists have found that laboratory diagnostics and medical history often give false positive results for food allergies in children. They conducted a study in which they gave patients at the age of six months a potential allergen under the supervision of doctors. It turned out that 94% of the children were on a diet unreasonably at the time of participation in the study and they had no reaction to the product under study. This method has been called a provocative test, and until recently there were no approved clinical protocols for its use in Russia. Now scientists are preparing documents for the introduction of this method, which will allow children to eat without restrictions in hospitals in the country.
How to treat food allergies in children
The introduction of provocative tests into clinical practice will help reduce the number of unjustified dietary restrictions and improve the quality of life of young patients, scientists from Sechenov University believe. In a study conducted jointly with the children's city clinical hospital No. 9 named after G.N. Speransky, they found out that the use of a potential allergen under the supervision of doctors is safe and allows you to accurately determine whether a child really has an allergy to a particular product. Moreover, scientists have found that laboratory diagnostics and medical history collection often give false positive results, doctors told Izvestia.
Food allergies are a potentially life—threatening condition that, according to various sources, affects up to 30% of Russians. The disease can manifest as skin rashes, respiratory symptoms, gastrointestinal disorders, and in severe cases— anaphylactic shock. As a rule, allergies are detected in childhood. Currently, the main diagnostic methods include medical history collection, laboratory tests, and an elimination diet, which involves eliminating a large number of foods from the diet and gradually adding them in search of the one that causes allergies. However, each of these methods has its drawbacks, from insufficient accuracy to significant economic and social impact on the child's family. Scarification tests, in which the allergen is applied to a small scratch on the skin, could provide a more accurate answer, however, reagents for food allergen samples are not available in the Russian Federation.
The researchers suggested using provocative samples, which are common in world practice, as a diagnostic tool. They have adapted an international protocol in which a child consumes an allergen (milk, egg) in increasing doses under medical supervision.
The study involved 130 children aged six months to 17 years with previously established or suspected allergies to milk and/or eggs. Based on the results of medical history collection and preliminary testing using blood analysis and skin testing, in which the potential allergen itself was applied directly to the punctured skin, children were selected who were shown an open provocative test. Then, in the intensive care unit, they received small portions of eggs or milk every 15 minutes. Doctors monitored the children for several hours after the last dose was administered.
— 94% of children at the time of participation in the study were on a diet unreasonably. Dietary restrictions also entail social restrictions — the child cannot eat with others, parents need to plan their diet separately, which requires time and additional costs. It is clear that no one at home will risk giving a potential allergen to a child. But provocative tests in conditions of access to emergency care make it possible to safely and reliably confirm whether a child has a food allergy," Lyudmila Fedorova, associate professor of Pediatrics and Pediatric Infectious Diseases at the N.F. Filatov Sechenov University Medical Center, told Izvestia.
How to make provocative samples
Among the children who underwent the provocative test procedure, there was not a single severe systemic allergic reaction. Among the patients who were on an elimination diet due to a previously established diagnosis of food allergy or suspicion of it, only 6% had a positive result. These children were diagnosed with food allergies and given recommendations on safe dietary alternatives.
This technique will form the basis of an updated clinical protocol for the diagnosis of food allergies, and methodological recommendations are currently being prepared. Further, the procedure will be implemented in clinical guidelines with subsequent integration into the list of services provided by all specialized hospitals of the DM and hospitals in other regions of the Russian Federation. This will help thousands of children across the country avoid unjustified dietary restrictions, scientists believe.
The topic of food allergies is becoming more and more relevant, Maxim Zolotov, an allergist and immunologist, market expert at NTI Helsnet, associate professor of the Department of Medical Microbiology and Immunology at the SamSMU of the Ministry of Health of the Russian Federation, Candidate of Medical Sciences, told Izvestia.
— Currently, allergists and immunologists are very short of approved clinical protocols that will allow conducting provocative tests. The administration of the allergen under the supervision of a doctor is safe for the patient and has high clinical significance. Mass use of protocols will allow timely diagnosis and correction of the patient's diet. The application of the technique will eliminate the need to cancel a large number of food products and will allow for the targeted cancellation of significant products," the expert said.
The study reproduces the "gold standard" for the diagnosis of food allergies, known worldwide for more than 30 years: an elimination diet with a provocative sample. The difference is that the diagnosis is performed in children from six months old in the intensive care unit (in case of a severe reaction), said Andrey Martyushev-Poklad, PhD, market expert at NTI Helsnet.
— The test is certainly necessary and relevant. It is somewhat puzzling why it was not widely implemented 10-15 years ago. Unfortunately, food allergies are often based on a violation (increase) of intestinal permeability, and along with an elimination diet, treatment should include actions aimed at this mechanism," the specialist said.
Among the immediate plans of scientists is to continue research on other food allergens.
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