Exclusively breastfed infants at risk for false negative double blind placebo controlled milk challenge

N.C.M. Petrus, E.A. Kole, A.A. Schoemaker; W.M.C. van Aalderen, A.B. Sprikkelman

The double blind placebo controlled food challenge (DBPCFC) is the gold standard for diagnosing cow's milk allergy (CMA). However, false-negative DBPCFC have been reported.
We present 2 cases with a false negative DBPCFC in exclusively breastfed infants suspected of CMA. These cases highlight the occurrence of severe allergic reactions of infants who were exclusively breastfed. Several reported causes of a false negative DBPCFC will be discussed.
However, there is currently no clear understanding of the cause of a false negative DBPCFC.
This paper highlights that a negative outcome of a DBFCFC must be interpreted with caution, because a severe allergic reaction might occur upon re-introduction of cow's milk. Therefore, an additional open food challenge under medical supervision is recommended in exclusively breastfed infants with a negative DBPCFC.
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