Reviewer's report
Title:Allergic proctocolitis refractory to maternal oligoantigenic diet in exclusively
breast-fed infants: a clinical observation.
Version: 2Date:1 March 2011
Reviewer: Jay Lieberman
Reviewer's report:
Major Compulsory Revisions -
I see no major compulsory revisions. This study is limited in scope and truthfully,
does not add very much to the field. In many ways, it simply confirms some of the
data already established in the field, such as that published by Dr. Lake in 2000.
It does add data on patch testing, and shows that patch testing was positive to
various proteins, but does not use this information in any way. Since all patients
that were patch tested were then placed on amino acid formula, how is one to
know the relevance of the patch test. If the patch test had never been done,
nothing would have changed clinically (i.e., all patients could have been put on
amino acid formula and improved without patch testing). Also, were any controls
(such as IgE-mediated food allergic children) patch tested to breast milk?
Perhaps controls would have positive testing to breast milk for example, as well.
Minor Essential Revisions --
1. Background - the data on the percentage requiring formula is not quite correct.
Lake showed that 12% of the children in his study required specialized formula.
7% responded to extensively hydrolyzed formula, while 5% required amino acid
formula. That is the larges case series that I am aware of.
2. Case Presentation - Authors state "mothers were on cow's milk and soy and/or
egg-free diets". It would be nice to know exactly how many were on which diet.
Were 7 on milk free? Were all 14 on milk free?
3. Case Presentation - In the description of the biopsies, it states "60 eosinophils
per 10 high power field in the lamina propria in almost one biopsy specimen in six
infants" is very confusing. What does this mean?
4. Discussion - In the second paragraph, it states "The prognosis is good with
gradual and complete resolution after 72-96 hours of maternal allergen
avoidance". I am assuming the authors mean that previous studies have shown
that, but their data argues that this is not the case in their patient population.
5. Conclusion - It states that biopsy is required to confirm a diagnosis. I think
many clinicians would argue this point. many clinicians will simply transition an
infant with hemotchezia only to an empiric trial of amino acid formula, and if the
bleeding resolves, no pursue any invasive testing.
Discretionary Revisions
It may benefit the paper to concentrate more on the patch testing if possible, as
this is really the novel part of the study.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Allergic proctocolitis refractory to maternal oligoantigenic diet in exclusively
breast-fed infants: a clinical observation.
Version: 2Date:1 March 2011
Reviewer: Jay Lieberman
Reviewer's report:
Major Compulsory Revisions -
I see no major compulsory revisions. This study is limited in scope and truthfully,
does not add very much to the field. In many ways, it simply confirms some of the
data already established in the field, such as that published by Dr. Lake in 2000.
It does add data on patch testing, and shows that patch testing was positive to
various proteins, but does not use this information in any way. Since all patients
that were patch tested were then placed on amino acid formula, how is one to
know the relevance of the patch test. If the patch test had never been done,
nothing would have changed clinically (i.e., all patients could have been put on
amino acid formula and improved without patch testing). Also, were any controls
(such as IgE-mediated food allergic children) patch tested to breast milk?
Perhaps controls would have positive testing to breast milk for example, as well.
Minor Essential Revisions --
1. Background - the data on the percentage requiring formula is not quite correct.
Lake showed that 12% of the children in his study required specialized formula.
7% responded to extensively hydrolyzed formula, while 5% required amino acid
formula. That is the larges case series that I am aware of.
2. Case Presentation - Authors state "mothers were on cow's milk and soy and/or
egg-free diets". It would be nice to know exactly how many were on which diet.
Were 7 on milk free? Were all 14 on milk free?
3. Case Presentation - In the description of the biopsies, it states "60 eosinophils
per 10 high power field in the lamina propria in almost one biopsy specimen in six
infants" is very confusing. What does this mean?
4. Discussion - In the second paragraph, it states "The prognosis is good with
gradual and complete resolution after 72-96 hours of maternal allergen
avoidance". I am assuming the authors mean that previous studies have shown
that, but their data argues that this is not the case in their patient population.
5. Conclusion - It states that biopsy is required to confirm a diagnosis. I think
many clinicians would argue this point. many clinicians will simply transition an
infant with hemotchezia only to an empiric trial of amino acid formula, and if the
bleeding resolves, no pursue any invasive testing.
Discretionary Revisions
It may benefit the paper to concentrate more on the patch testing if possible, as
this is really the novel part of the study.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Allergic proctocolitis refractory to maternal oligoantigenic diet in exclusively
breast-fed infants: a clinical observation.
Version: 2Date:1 March 2011
Reviewer: Jay Lieberman
Reviewer's report:
Major Compulsory Revisions -
I see no major compulsory revisions. This study is limited in scope and truthfully,
does not add very much to the field. In many ways, it simply confirms some of the
data already established in the field, such as that published by Dr. Lake in 2000.
It does add data on patch testing, and shows that patch testing was positive to
various proteins, but does not use this information in any way. Since all patients
that were patch tested were then placed on amino acid formula, how is one to
know the relevance of the patch test. If the patch test had never been done,
nothing would have changed clinically (i.e., all patients could have been put on
amino acid formula and improved without patch testing). Also, were any controls
(such as IgE-mediated food allergic children) patch tested to breast milk?
Perhaps controls would have positive testing to breast milk for example, as well.
Minor Essential Revisions --
1. Background - the data on the percentage requiring formula is not quite correct.
Lake showed that 12% of the children in his study required specialized formula.
7% responded to extensively hydrolyzed formula, while 5% required amino acid
formula. That is the larges case series that I am aware of.
2. Case Presentation - Authors state "mothers were on cow's milk and soy and/or
egg-free diets". It would be nice to know exactly how many were on which diet.
Were 7 on milk free? Were all 14 on milk free?
3. Case Presentation - In the description of the biopsies, it states "60 eosinophils
per 10 high power field in the lamina propria in almost one biopsy specimen in six
infants" is very confusing. What does this mean?
4. Discussion - In the second paragraph, it states "The prognosis is good with
gradual and complete resolution after 72-96 hours of maternal allergen
avoidance". I am assuming the authors mean that previous studies have shown
that, but their data argues that this is not the case in their patient population.
5. Conclusion - It states that biopsy is required to confirm a diagnosis. I think
many clinicians would argue this point. many clinicians will simply transition an
infant with hemotchezia only to an empiric trial of amino acid formula, and if the
bleeding resolves, no pursue any invasive testing.
Discretionary Revisions
It may benefit the paper to concentrate more on the patch testing if possible, as
this is really the novel part of the study.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant