9 and 45 The diagnostic confirmation is based on the favorable clinical response by the patient after the start of the allergen elimination diet (cow’s milk) and recurrence of bleeding with the reintroduction (allergy challenge test) of cow’s milk protein in the diet.5, 44 and 45 The allergy challenge test is considered the most reliable method for the diagnosis of food allergy.9 It can be performed in three different ways: non-blind (open), single-blind, and double-blind

placebo-controlled test.9 The two blinded modalities should be used when the clinical manifestations are subjective. In the case of infants, the non-blind allergy challenge test is traditionally recommended.9 and 45 It BMS-907351 datasheet is noteworthy that only 12 of the 32 articles analyzed in this review sought to confirm the diagnosis with an allergy challenge test. 78.8% of the patients who were submitted to the allergy challenge

test after 12 months of age showed negative result, indicating the development of tolerance. Conversely, when the allergy challenge test was performed two to three months after the start of the elimination diet, the diagnosis was confirmed in 72.4% of patients. Thus, when tested, the diagnosis of CMA is confirmed early in most patients, whereas after 12 months, the development of tolerance to cow’s milk proteins is usually observed. Many authors do not use the allergy challenge test to diagnose food allergy, which is the reason for the large discrepancy in reported prevalence and incidence of food allergy. A cohort study that isothipendyl followed 480 children from birth Duvelisib concentration to 3 years of age showed that 28% of parents thought that their children’s symptoms could be due to food allergy, especially in the first year of life. Conversely, when the allergy challenge test was

performed, the diagnosis was confirmed in only 8% of cases. This result shows the importance of completing the allergy challenge test in the diagnosis of food allergy, avoiding unnecessary costs and maintenance of an elimination diet.48 Additionally, the possibility of tolerance development during the interval between the diagnosis and the allergy challenge test cannot be ruled out. In this context, it should be noted that, since the 1990s, the European Society of Pediatric Gastroenterology and Nutrition has considered the non-blind allergy challenge test appropriate for infants, in view of the fact that at this age range the suggestion component induced by the test is virtually nonexistent.9 and 49 It should be noted that allergy challenge tests should not be performed if there is risk of anaphylaxis. It is currently recommended to start the test in a hospital environment.9 and 45 The diagnostic workup can be performed by invasive procedures such as sigmoidoscopy and colonoscopy, always associated with local biopsies.