European Journal of Pediatrics

, Volume 178, Issue 7, pp 1113–1117 | Cite as

The effect of follow-up after a negative double-blinded placebo-controlled cow’s milk challenge on successful reintroduction

  • Michael SchrijversEmail author
  • Tom Hendriks
  • Hanneke Mars
  • Imke Annelieke Bertrams-Maartens
Original Article


Cow’s milk allergy is a common food allergy in children with an incidence of 1–3%. The gold standard to diagnose cow’s milk allergy is a double-blinded placebo-controlled food challenge (DBPCFC). Previous studies show that reintroduction of cow’s milk is unsuccessful in 10–12% of patients. The aim of this retrospective study is to evaluate the effect of follow-up on the reintroduction of cow’s milk. We analyzed the data of patients with a negative DBPCFC for cow’s milk between 2014 and 2016 in three different departments. Questionnaires were used to compare the three ways of follow-up (no follow-up, follow-up in person or by telephone). Of the 336 children with a negative DBPCFC for cow’s milk, 128 questionnaires (41%) were returned. Reintroduction of cow’s milk was unsuccessful in 13.3% of the patients. There was no significant difference found between children with (73.8%) or without (26.2%) follow-up, or between follow-up by phone or personally. Whether this finding is caused by small numbers within this retrospective study should be investigated in future prospective studies.

Conclusion: Follow-up does not influence the reintroduction success rate of cow’s milk after a negative double-blinded placebo-controlled food challenge.

What is Known:

Diagnosis of cow’s milk allergy by double-blinded placebo-controlled food challenge is the gold standard.

• After a negative double-blinded placebo-controlled food challenge, reintroduction of cow’s milk in the child’s diet is unsuccessful in 10–12% of the children.

• Recurrence of symptoms, aversion to the examined food, and fear are seen as the main reasons for unsuccessful introduction.

What is New:

• Reintroduction after a negative double-blinded placebo-controlled food challenge is not influenced by different ways of follow-up.


Management Allergy Hypersensitivity Children Double-blinded placebo-controlled food challenge Introduction failure 



Cow’s milk allergy


Double-blinded placebo-controlled food challenge


Child health care center


Author Contribution

Author 1 collected the data, performed the analysis and wrote the paper. Author 2 and 3 conceived and designed the analysis. Author 4 conceived and designed the analysis and wrote the paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was submitted to the Medical Ethical Committee of the Maxima Medical Centre for approval. The Committee concluded that no Ethical Approval was required as it concerned a retrospective study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Máxima Medical Centre (MMC)VeldhovenThe Netherlands
  2. 2.Catharina HospitalEindhovenThe Netherlands
  3. 3.Zuid Zorg, Child Health CentreVeldhovenThe Netherlands

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