Reviewer's report
Title:Allergic proctocolitis refractory to maternal oligoantigenic diet in exclusively
breast-fed infants: a clinical observation.
Version: 3Date:1 June 2011
Reviewer: Ralf G Heine
Reviewer's report:
The overall quality of the paper is improved after the extensive revision by the
authors. The addition of Table 1 has made the clinical detail provided much
clearer. However, some limitations remain, mainly relating to the assessment of
the diagnostic accuracy and clinical usefulness of atopy patch testing in this
cohort of patients. At the start of the discussion the authors state:
“APT positivity for foods and breast milk, in our case series of exclusively
breast-fed infants with APC, confirms the hypothesis that food proteins can be
transferred through lactation and are potentially able to induce an allergic
reaction in infants.”
And conclude by saying:
“We suggest patch testing for foods could become an important diagnostic tool to
identify a polisensitization, with the potential objective to correctly address the
maternal diet. Patch testing for breast milk seems to be able to demonstrate the
passage of food proteins deriving from the maternal diet in exclusively breast-fed
infants.”
However, this is an over-interpretation of the available APT results from this
study as results were not confirmed by food challenge. Instead, all infants were
placed on an elemental diet. It therefore remains unclear what proportion of
infants had false-positive or false-negative results. For example, only half of
infants had a positive patch test to cow’s milk but the authors assumed that
allergic proctocolitis was mainly due to cow’s milk proteins transferred through
breast milk. This would suggest a false-negative rate of about 50% and illustrates
that the APT most likely has a low sensitivity which would significantly limit its
usefulness as a diagnostic tool.
The authors can safely deduct from their study that allergic proctocolitis in infants
is a non-IgE-mediated condition. In addition, all infants who failed to respond to a
maternal elimination diet improved on amino acid-based formula (AAF). This is
useful clinical information. However, it does not necessarily imply an allergic
mechanism as food challenges were not performed.
In summary, the role of the APT as a diagnostic tool in this study remains
speculative and is not backed up by the data provided. These limitations should
be made clearer in the discussion.
Reviewer's report
Title:Allergic proctocolitis refractory to maternal oligoantigenic diet in exclusively
breast-fed infants: a clinical observation.
Version: 3Date:1 June 2011
Reviewer: Ralf G Heine
Reviewer's report:
The overall quality of the paper is improved after the extensive revision by the
authors. The addition of Table 1 has made the clinical detail provided much
clearer. However, some limitations remain, mainly relating to the assessment of
the diagnostic accuracy and clinical usefulness of atopy patch testing in this
cohort of patients. At the start of the discussion the authors state:
“APT positivity for foods and breast milk, in our case series of exclusively
breast-fed infants with APC, confirms the hypothesis that food proteins can be
transferred through lactation and are potentially able to induce an allergic
reaction in infants.”
And conclude by saying:
“We suggest patch testing for foods could become an important diagnostic tool to
identify a polisensitization, with the potential objective to correctly address the
maternal diet. Patch testing for breast milk seems to be able to demonstrate the
passage of food proteins deriving from the maternal diet in exclusively breast-fed
infants.”
However, this is an over-interpretation of the available APT results from this
study as results were not confirmed by food challenge. Instead, all infants were
placed on an elemental diet. It therefore remains unclear what proportion of
infants had false-positive or false-negative results. For example, only half of
infants had a positive patch test to cow’s milk but the authors assumed that
allergic proctocolitis was mainly due to cow’s milk proteins transferred through
breast milk. This would suggest a false-negative rate of about 50% and illustrates
that the APT most likely has a low sensitivity which would significantly limit its
usefulness as a diagnostic tool.
The authors can safely deduct from their study that allergic proctocolitis in infants
is a non-IgE-mediated condition. In addition, all infants who failed to respond to a
maternal elimination diet improved on amino acid-based formula (AAF). This is
useful clinical information. However, it does not necessarily imply an allergic
mechanism as food challenges were not performed.
In summary, the role of the APT as a diagnostic tool in this study remains
speculative and is not backed up by the data provided. These limitations should
be made clearer in the discussion.
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: 3Date:1 June 2011
Reviewer: Ralf G Heine
Reviewer's report:
The overall quality of the paper is improved after the extensive revision by the
authors. The addition of Table 1 has made the clinical detail provided much
clearer. However, some limitations remain, mainly relating to the assessment of
the diagnostic accuracy and clinical usefulness of atopy patch testing in this
cohort of patients. At the start of the discussion the authors state:
“APT positivity for foods and breast milk, in our case series of exclusively
breast-fed infants with APC, confirms the hypothesis that food proteins can be
transferred through lactation and are potentially able to induce an allergic
reaction in infants.”
And conclude by saying:
“We suggest patch testing for foods could become an important diagnostic tool to
identify a polisensitization, with the potential objective to correctly address the
maternal diet. Patch testing for breast milk seems to be able to demonstrate the
passage of food proteins deriving from the maternal diet in exclusively breast-fed
infants.”
However, this is an over-interpretation of the available APT results from this
study as results were not confirmed by food challenge. Instead, all infants were
placed on an elemental diet. It therefore remains unclear what proportion of
infants had false-positive or false-negative results. For example, only half of
infants had a positive patch test to cow’s milk but the authors assumed that
allergic proctocolitis was mainly due to cow’s milk proteins transferred through
breast milk. This would suggest a false-negative rate of about 50% and illustrates
that the APT most likely has a low sensitivity which would significantly limit its
usefulness as a diagnostic tool.
The authors can safely deduct from their study that allergic proctocolitis in infants
is a non-IgE-mediated condition. In addition, all infants who failed to respond to a
maternal elimination diet improved on amino acid-based formula (AAF). This is
useful clinical information. However, it does not necessarily imply an allergic
mechanism as food challenges were not performed.
In summary, the role of the APT as a diagnostic tool in this study remains
speculative and is not backed up by the data provided. These limitations should
be made clearer in the discussion.
assistant