100448 - Aspects related to anaphylaxis in oral food challenge for cow’s milk in a tertiary pediatric hospital

Food allergy is a hypersensitivity reaction triggered by immunological mechanisms and cow's milk protein allergy (CMPA)  is the most common food allergen in the pediatric population. The oral food challenge (OFC) is the gold standard method for diagnostic confirmation or for assessing food tolerance. Serious reactions such as anaphylaxis can occur and should be suspected quickly and treatment instituted immediately. Objective: Evaluate and describe the main factors related to anaphylaxis during OFC in patients with IgE mediated allergy to CMPA. 

Observational and analytical study, with evaluation of electronic medical records of patients who underwent OFC with CMPA (fresh or baked milk products) and presented anaphylaxis during the test. Demographic data, history and results of complementary exams were evaluated. The severity of anaphylaxis was classified according to symptoms and the number of doses of adrenaline. 

Of the 338 tests evaluated, 28 (8.2%) showed an anaphylactic reaction. Four were classified as grade III and five required more than one dose of adrenaline. Only one biphasic reaction was observed. The number of adrenaline doses was statistically related to the severity of symptoms (p=0.024). There were no patients with grade IV anaphylaxis. There was a prevalence of reactions in patients who underwent testing with baked milk products. Hoarseness (p = 0.043) and syncope (p = 0.043) were associated with severe anaphylaxis. 

Anaphylaxis is a rare, but serious reaction that can be present in OFCs and a well-prepared environment and trained staff in the correct management of each reaction are essential.