Supplementary Material for: Asthmatic Response to Milk Ingestion Challenge in Adults: A Comparison of the Open and Double-Blind Challenges

Background: Cow’s milk allergy can participate in pathophysiological mechanisms underlying bronchial asthma in some adult patients. This role should ultimately be confirmed by means of a milk ingestion challenge. In this study, the diagnostic value of the open food ingestion challenge (OFICH) and the double-blind placebo-controlled food challenge (DBPCFC) techniques with milk were compared in adult patients suffering from bronchial asthma with suspected milk allergy. Methods: In 87 asthmatics with a suspected history and positive skin tests for milk, the 87 OFICHs and DBPCFCs were performed in combination with spirometry and followed up to 72 h after the challenge. Results: Of 87 patients, 74 (85%) developed a positive asthmatic response (AR) (20 immediate, 33 late, 6 dual late and 15 delayed; p < 0.01) and 13 (15%) developed a negative AR (p > 0.1) to OFICH. Seventy-five (86%) developed a positive AR (17 immediate, 35 late, 8 dual late and 15 delayed; p < 0.01) and 12 (14%) developed a negative AR (p > 0.05) to DBPCFC. The correlation between the OFICH and DBPCFC was statistically significant (p < 0.01). All placebo control challenges were negative (p > 0.2). Conclusions: In some adults with bronchial asthma, involvement of an allergy to cow’s milk results in the appearance of various AR types (immediate, late, dual late or delayed). The milk allergy can be confirmed by open or double-blind techniques, combined with spirometry. No significant differences were found between the OFICH and DBPCFC results. OFICH with natural milk combined with spirometry seems, therefore, to be an adequate technique for the detection of milk allergy in asthmatics. The DBPCFC can be performed as an additional check, if necessary.

背景：牛乳过敏可参与部分成人患者支气管哮喘的病理生理进程。该致病作用最终需通过牛乳摄入激发试验予以证实。本研究针对疑似合并牛乳过敏的成人支气管哮喘患者，对比了开放式食物摄入激发试验（open food ingestion challenge, OFICH）与双盲安慰剂对照食物摄入激发试验（double-blind placebo-controlled food challenge, DBPCFC）的诊断价值。
方法：纳入87例存在可疑牛乳过敏史且牛乳皮肤试验呈阳性的哮喘患者，对其同时开展OFICH与DBPCFC检测，同步进行肺量计监测，并于激发试验后随访72小时。
结果：87例受试者中，74例（85%）在OFICH检测中出现阳性哮喘反应（asthmatic response, AR），其中速发型20例、迟发型33例、双重迟发型6例、延迟型15例（P<0.01）；13例（15%）OFICH检测结果为阴性哮喘反应（P>0.1）。DBPCFC检测中，75例（86%）出现阳性AR，包括速发型17例、迟发型35例、双重迟发型8例、延迟型15例（P<0.01）；12例（14%）检测结果为阴性AR（P>0.05）。OFICH与DBPCFC的检测结果具有统计学相关性（P<0.01）。所有安慰剂对照激发试验结果均为阴性（P>0.2）。
结论：在部分成人支气管哮喘患者中，牛乳过敏参与发病可表现为多种类型的AR（速发型、迟发型、双重迟发型或延迟型）。通过开放式或双盲激发试验联合肺量计检测，可明确诊断牛乳过敏。OFICH与DBPCFC的检测结果无显著统计学差异。因此，联合肺量计监测的天然牛乳OFICH可作为哮喘患者牛乳过敏检测的可靠方法，必要时可辅以DBPCFC作为补充验证。