Research Letter
Successful oral tolerance induction to cow's milk in a child with allergy to extensively hydrolysed formula
N. Santos, A. Gaspar
, L.M. Borrego, M. Morais-Almeida
Corresponding author
Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
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(A) Fresh coconut extract. (B) Coconut milk extract. Lane P: patient serum. Lane C: control serum (pool of sera from non-atomic subject). Lane M: molecular mass marker.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Michavila Gomez, M. Amat Bou, M.V. Gonzalez Cortés, L. Segura Navas, M.A. Moreno Palanques, B. Bartolomé" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Michavila Gomez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Amat Bou" ] 2 => array:2 [ "nombre" => "M.V." "apellidos" => "Gonzalez Cortés" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Segura Navas" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Moreno Palanques" ] 5 => array:2 [ "nombre" => "B." 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A case of anaphylaxis caused by skin prick testing with inhalant allergens" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215" "paginaFinal" => "216" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Babayigit Hocaoglu, F. Cipe, C. Aydogmus" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Babayigit Hocaoglu" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Cipe" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Aydogmus" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461300284X?idApp=UINPBA00004N" "url" => "/03010546/0000004300000002/v2_201503200840/S030105461300284X/v2_201503200840/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Successful oral tolerance induction to cow's milk in a child with allergy to extensively hydrolysed formula" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "216" "paginaFinal" => "218" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Santos, A. Gaspar, L.M. Borrego, M. Morais-Almeida" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Santos" ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Gaspar" "email" => array:1 [ 0 => "angela.gaspar@sapo.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "L.M." "apellidos" => "Borrego" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Morais-Almeida" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cow's milk allergy (CMA) is the most frequent food allergy in childhood.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Treatment consists of cow's milk proteins eviction, with the use of an extensively hydrolysed milk formula (eHF) being the first option in most cases, due to its good tolerance, availability and cost.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Few cases of IgE-mediated allergy to eHF have been reported<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–6</span></a> but oral tolerance induction (OIT) has not been previously described in children with allergy to eHF.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a boy, referred to our Immunoallergy department in 2010, at the age of five years, whose parents reported a severe IgE-mediated CMA diagnosed at six months of age following an episode of anaphylaxis, with generalised urticaria, angio-oedema, rhinoconjunctivitis and wheeze after yoghourt ingestion, and vomiting after eating a milk-containing puree. The child began cow's milk avoidance and was started on an eHF (Aptamil<span class="elsevierStyleSup">®</span>Pepti Junior, Milupa). However, several episodes of reproducible urticaria occurred immediately after eHF introduction, for which it was stopped and a soy milk formula was prescribed. At that time the child had specific IgE (ImmunoCAP<span class="elsevierStyleSup">®</span>, Phadia – Thermo Fisher Scientific, Uppsala, Sweden) positive for whole cow's milk (55.2<span class="elsevierStyleHsp" style=""></span>kU/L), casein (54.8<span class="elsevierStyleHsp" style=""></span>kU/L), β-lactoglobulin (BLG) (16.6<span class="elsevierStyleHsp" style=""></span>kU/L) and α-lactalbumin (ALA) (42.9<span class="elsevierStyleHsp" style=""></span>kU/L), and negative for soy. Due to food protein-induced enterocolitis syndrome with soy milk, manifesting as recurrent diarrhoea beginning three weeks after soy milk introduction, the child was started on an aminoacid formula (Neocate<span class="elsevierStyleSup">®</span>, Nutricia), which he maintained at the time of the consultation with good tolerance and adequate growth. The parents reported several episodes of contact urticaria on occasional mucocutaneous contact with cow's milk, and no episodes of accidental cow's milk ingestion.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The child also presented with symptoms of asthma since early childhood, controlled with inhaled fluticasone through a spacer device, mild persistent rhinitis treated with nasal mometasone furoate, mild atopic dermatitis and a family history of atopy (father and brother with asthma and rhinitis).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Skin prick tests (SPT) (Laboratorios Leti, Madrid, Spain) at the age of five years were positive for whole cow's milk (mean wheal diameter<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm), casein (10<span class="elsevierStyleHsp" style=""></span>mm), BLG (9<span class="elsevierStyleHsp" style=""></span>mm), ALA (8<span class="elsevierStyleHsp" style=""></span>mm) and eHF (Aptamil<span class="elsevierStyleSup">®</span>Pepti Junior, Milupa) (8<span class="elsevierStyleHsp" style=""></span>mm). As a control, due to the fact that the SPT with eFH is not standardised, we performed SPT with this eHF in 10 CMA children, which was negative in all of them. SPT were negative for aeroallergens and soy extract. Specific IgE (ImmunoCAP<span class="elsevierStyleSup">®</span>, Phadia – Thermo Fisher Scientific) was positive for whole cow's milk (36.0<span class="elsevierStyleHsp" style=""></span>kU/L), casein (33.4<span class="elsevierStyleHsp" style=""></span>kU/L), BLG (12.3<span class="elsevierStyleHsp" style=""></span>kU/L) and ALA (22.1<span class="elsevierStyleHsp" style=""></span>kU/L).</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the age of six years, an open oral provocation test with cow's milk was performed, which was positive 17<span class="elsevierStyleHsp" style=""></span>min after ingestion of 1<span class="elsevierStyleHsp" style=""></span>mL of cow's milk, with generalised urticaria, rhinoconjunctivitis and palpebral oedema. The child presented no respiratory, gastrointestinal or cardiovascular symptoms and was treated with oral antihistamine and corticosteroid with complete resolution in 3<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the persistence of cow's milk allergy at the age of six years, an oral tolerance induction (OTI) procedure was proposed and consented by the parents, which was completed in 30 weeks (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Since then, the child maintains a daily intake of 200<span class="elsevierStyleHsp" style=""></span>mL once a day, with progressive introduction of other milk containing foods with tolerance.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Skin prick tests four weeks after OIT were positive for cow's milk (4<span class="elsevierStyleHsp" style=""></span>mm), casein (4<span class="elsevierStyleHsp" style=""></span>mm), BLG (5<span class="elsevierStyleHsp" style=""></span>mm) and ALA (3<span class="elsevierStyleHsp" style=""></span>mm) and negative for eHF. Skin prick tests one year after OIT were positive for casein (3<span class="elsevierStyleHsp" style=""></span>mm), BLG (4<span class="elsevierStyleHsp" style=""></span>mm) and ALA (3<span class="elsevierStyleHsp" style=""></span>mm) and negative for cow's milk. Data on specific IgE and IgG<span class="elsevierStyleInf">4</span> before, during and after OIT are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Comments</span><p id="par0040" class="elsevierStylePara elsevierViewall">Milk allergens are known to preserve their biological activity even after boiling, pasteurisation, ultra-high temperature processing or evaporation, which is the reason why extensive hydrolysis is necessary to obtain hypoallergenic formulas (1); eHFs can be produced from casein or whey proteins and have been characterised as those in which ≥95% of peptides have a molecular weight <1500<span class="elsevierStyleHsp" style=""></span>Da and less than 0.5% have a molecular weight >6000<span class="elsevierStyleHsp" style=""></span>Da (2), although there is no agreement on these criteria.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Allergic reactions, IgE and non-IgE mediated, to both casein and whey protein eHFs, have been previously reported (2–6). Our patient presented with anaphylaxis to cow's milk and urticaria to an extensively hydrolysed whey protein formula due to an IgE-mediated mechanism, confirmed by skin prick test positivity.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Although CMA is mainly due to the IgE binding to conformational epitopes, Matsumoto et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have demonstrated the IgE binding to linear epitopes from caseins and also from whey proteins such as ALA and BLG and that the pattern of IgE and IgG4 reactivity to these epitopes could differentiate sensitisation from transient and persistent CMA. Moreover, despite extensively hydrolysed casein formula showing a better safety profile than that of whey hydrolysates,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> it still contains trace amounts of casein and whey,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which may be responsible for the clinical reactivity in some patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">No previous studies have compared children's allergy and tolerance to eHF in relation to severity and duration of CMA, or to values of specific IgE or skin prick tests to cow's milk and proteins, but one might hypothesise that allergy to eHF could be a marker of severity, since children react to linear epitopes and/or to trace amounts of cow's milk proteins, which is also consistent with the high specific IgE found in our patient prior to OIT.</p><p id="par0060" class="elsevierStylePara elsevierViewall">García-Ara et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have reported that milk OIT is achieved earlier in children with low specific IgE and that those allergic children with higher cow's milk specific IgE levels (>11.4<span class="elsevierStyleHsp" style=""></span>kU/L) experience more frequent and severe adverse reactions during the procedure. Morais-Almeida et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> have reported achievement of a 200<span class="elsevierStyleHsp" style=""></span>mL maintenance dose in a mean of four (from 3 to 6) hospital visits and 12 (from 6 to 20) weeks in children with anaphylaxis to cow's milk, using the same OIT protocol, with 2/10 children presenting anaphylactic reactions and 8/10 children presenting a total of 13 mild to moderate reactions treated with oral antihistamines or corticosteroids during induction phase. This is in contrast with the longer period of time (30 weeks) and number of visits (seven visits) needed to achieve tolerance in the reported patient and to the more frequent adverse reactions, although all the reactions were mild to moderate (five reactions at the hospital and four at home).</p><p id="par0065" class="elsevierStylePara elsevierViewall">To the best of our knowledge, this is the first report of a patient with eHF allergy treated with OIT. We emphasise that despite OIT taking a longer time and with more adverse events than previously reported by the authors,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> tolerance of 200<span class="elsevierStyleHsp" style=""></span>mL of cow's milk plus a free diet was achieved and a decrease of specific IgE/IgG4 ratio as well as in skin prick test size to whole cow's milk and its proteins was observed. Moreover, the previously positive skin prick test to the eHF turned negative after successful OIT.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Confidentiality of data</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that the parents of the patient included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Right to privacy and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the parents of the patient mentioned in the article. The author for correspondence is in possession of this document.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Comments" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Right to privacy and informed consent" ] ] ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">OIT initiated with sublingual drops with 20-min interval. Oral doses with 30-min interval between intakes, except when specified otherwise.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 1(Day 1) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 2(Day 27)Week 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 3(Day 76)Week 10 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 4(Day 104)Week 14 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 5(Day 125)Week 17 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 6(Day 181)Week 25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 7(Day 216)Week 30 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Dose increase at the hospital</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 drop \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 drops \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 drops \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4 drops \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.1<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.2<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>mL<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(2h interval)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Maintenance dose at home after the visit</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>mL bid<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mL bid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mL bid<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>mL bid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mL bid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>mL bid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200<span class="elsevierStyleHsp" style=""></span>mL id \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab710905.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cow's milk intake done at home before the visit.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Allergic reaction (cutaneous erythema and rhinitis), self-limited, without medication needed.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">After a meal (breakfast/dinner) and advised to avoid vigorous exercise in the two subsequent hours, bid: twice a day, id: once a day.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">2 reactions of rhinoconjunctivitis and 1 of facial and trunk urticaria at home, within 15<span class="elsevierStyleHsp" style=""></span>min after milk intake, self-limited.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">1 reaction at home 5<span class="elsevierStyleHsp" style=""></span>min after intake, with headache and facial urticaria, treated with oral antihistamine and corticosteroid.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cow's milk oral tolerance induction protocol.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ND, not done.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">IgE/IgG4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Before OIT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">During OIT</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After OIT</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Week 12 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Week 28 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Week 4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">6 months \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 year \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cow's milk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.3/ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9/25,433 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.38/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.99/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.53/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.76/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Casein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.2/884 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.82/15,047 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.35/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.51/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.15/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.12/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BLG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7/1021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.65/7773 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.37/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.74/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.19/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.59/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ALA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.59/446 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4/26,926 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.64/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.82/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.35/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.02/>30,000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab710906.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Specific IgE (kU/L) and IgG4 (mg/L) to cow's milk and cow's milk proteins before, during and after oral tolerance induction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World Allergy Organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Fiocchi" 1 => "J. Brozek" 2 => "H. Schünemann" 3 => "S.L. Bahna" 4 => "A. von Berg" 5 => "K. Beyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3038.2010.01068.x" "Revista" => array:7 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2010" "volumen" => "21" "numero" => "Suppl. 21" "paginaInicial" => "1" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20618740" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensively hydrolyzed formulas allergy – 3 clinical reports" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Sampaio" 1 => "A.M. Romeira" 2 => "C. Arêde" 3 => "S. Prates" 4 => "G. Pires" 5 => "M. Morais-Almeida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Imunoalergol" "fecha" => "2003" "volumen" => "11" "paginaInicial" => "41" "paginaFinal" => "45" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of allergenicity to three cows milk hydrolysates and an amino acid derived formula in children with cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Caffarelli" 1 => "A. Plebani" 2 => "C. Poiesi" 3 => "T. Petroccione" 4 => "A. Spattini" 5 => "G. Cavagni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Allergy" "fecha" => "2002" "volumen" => "32" "paginaInicial" => "74" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12002741" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of allergy to cow's milk hydrolysate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Nilsson" 1 => "H. Oman" 2 => "G. Hallden" 3 => "G. Lilja" 4 => "M. Lundberg" 5 => "B. Harfast" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "1999" "volumen" => "54" "paginaInicial" => "1322" "paginaFinal" => "1326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10688438" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergenicity of milk proteins hydrolysate formula in children with cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Ragno" 1 => "P.G. Giampietro" 2 => "G. Bruno" 3 => "L. Businco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "1993" "volumen" => "152" "paginaInicial" => "760" "paginaFinal" => "762" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8223811" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anaphylatic reactions to a cow's milk whey hydrolysate (Alfa-Ré Nestlé) in infants with cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Businco" 1 => "A. Cantani" 2 => "M.A. Longhi" 3 => "P.G. Giampietro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Allergy" "fecha" => "1989" "volumen" => "62" "paginaInicial" => "333" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2705659" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peptide array-based analysis of the specific IgE and IgG4 in cow's milk allergens and its use in allergy evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Matsumoto" 1 => "M. Okochi" 2 => "M. Matsushima" 3 => "R. Kato" 4 => "T. Takase" 5 => "Y. Yoshida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.peptides.2009.07.005" "Revista" => array:6 [ "tituloSerie" => "Peptides" "fecha" => "2009" "volumen" => "30" "paginaInicial" => "1840" "paginaFinal" => "1847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19619602" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum specific-IgE antibodies to peptides detected in casein hydrolysate formula" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.M. Hoffman" 1 => "H.A. Sampson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "1997" "volumen" => "8" "paginaInicial" => "185" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9553983" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. García-Ara" 1 => "M. Pedrosa" 2 => "M.T. Belver" 3 => "M.F. Martín-Muñoz" 4 => "S. Quirce" 5 => "T. Boyano-Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anai.2013.01.013" "Revista" => array:6 [ "tituloSerie" => "Ann Allergy Asthma Immunol" "fecha" => "2013" "volumen" => "110" "paginaInicial" => "290" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23535095" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Innovation in specific oral tolerance induction in children with anaphylaxis to cow's milk proteins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Morais-Almeida" 1 => "S. Piedade" 2 => "M. Couto" 3 => "G. Sampaio" 4 => "C. Santa-Marta" 5 => "A. Gaspar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Imunoalergol" "fecha" => "2011" "volumen" => "19" "paginaInicial" => "161" "paginaFinal" => "169" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004300000002/v2_201503200840/S0301054614000214/v2_201503200840/en/main.assets" "Apartado" => array:4 [ "identificador" => "5550" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004300000002/v2_201503200840/S0301054614000214/v2_201503200840/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054614000214?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 17 | 16 | 33 |
| 2024 September | 24 | 11 | 35 |
| 2024 August | 12 | 1 | 13 |
| 2024 July | 17 | 4 | 21 |
| 2024 June | 14 | 5 | 19 |
| 2024 May | 10 | 7 | 17 |
| 2024 April | 19 | 28 | 47 |
| 2024 March | 28 | 8 | 36 |
| 2024 February | 28 | 6 | 34 |
| 2024 January | 27 | 10 | 37 |
| 2023 December | 24 | 18 | 42 |
| 2023 November | 19 | 7 | 26 |
| 2023 October | 23 | 3 | 26 |
| 2023 September | 34 | 8 | 42 |
| 2023 August | 21 | 12 | 33 |
| 2023 July | 22 | 9 | 31 |
| 2023 June | 23 | 8 | 31 |
| 2023 May | 49 | 9 | 58 |
| 2023 April | 53 | 4 | 57 |
| 2023 March | 46 | 0 | 46 |
| 2023 February | 31 | 9 | 40 |
| 2023 January | 17 | 7 | 24 |
| 2022 December | 19 | 8 | 27 |
| 2022 November | 21 | 11 | 32 |
| 2022 October | 23 | 21 | 44 |
| 2022 September | 23 | 13 | 36 |
| 2022 August | 32 | 12 | 44 |
| 2022 July | 24 | 15 | 39 |
| 2022 June | 32 | 6 | 38 |
| 2022 May | 26 | 11 | 37 |
| 2022 April | 19 | 15 | 34 |
| 2022 March | 25 | 10 | 35 |
| 2022 February | 46 | 6 | 52 |
| 2022 January | 28 | 9 | 37 |
| 2021 December | 45 | 9 | 54 |
| 2021 November | 20 | 22 | 42 |
| 2021 October | 35 | 28 | 63 |
| 2021 September | 22 | 12 | 34 |
| 2021 August | 29 | 16 | 45 |
| 2021 July | 23 | 12 | 35 |
| 2021 June | 16 | 19 | 35 |
| 2021 May | 28 | 16 | 44 |
| 2021 April | 52 | 33 | 85 |
| 2021 March | 21 | 14 | 35 |
| 2021 February | 16 | 18 | 34 |
| 2021 January | 15 | 3 | 18 |
| 2020 December | 3 | 2 | 5 |
| 2020 November | 0 | 4 | 4 |
| 2020 October | 1 | 0 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2020 May | 0 | 4 | 4 |
| 2020 April | 0 | 3 | 3 |
| 2020 March | 0 | 5 | 5 |
| 2020 February | 0 | 8 | 8 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 0 | 2 | 2 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 4 | 4 |
| 2019 August | 0 | 5 | 5 |
| 2019 July | 1 | 6 | 7 |
| 2019 June | 0 | 5 | 5 |
| 2019 May | 0 | 3 | 3 |
| 2019 April | 0 | 6 | 6 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 0 | 2 | 2 |
| 2019 January | 0 | 4 | 4 |
| 2018 December | 0 | 3 | 3 |
| 2018 November | 0 | 7 | 7 |
| 2018 August | 0 | 1 | 1 |
| 2018 February | 6 | 2 | 8 |
| 2018 January | 10 | 2 | 12 |
| 2017 December | 8 | 2 | 10 |
| 2017 November | 13 | 2 | 15 |
| 2017 October | 10 | 5 | 15 |
| 2017 September | 4 | 2 | 6 |
| 2017 August | 11 | 8 | 19 |
| 2017 July | 21 | 4 | 25 |
| 2017 June | 14 | 8 | 22 |
| 2017 May | 28 | 8 | 36 |
| 2017 April | 21 | 2 | 23 |
| 2017 March | 12 | 19 | 31 |
| 2017 February | 16 | 4 | 20 |
| 2017 January | 13 | 4 | 17 |
| 2016 December | 18 | 8 | 26 |
| 2016 November | 25 | 13 | 38 |
| 2016 October | 29 | 11 | 40 |
| 2016 September | 12 | 7 | 19 |
| 2016 August | 21 | 9 | 30 |
| 2016 July | 14 | 1 | 15 |
| 2016 June | 21 | 15 | 36 |
| 2016 May | 21 | 12 | 33 |
| 2016 April | 18 | 15 | 33 |
| 2016 March | 19 | 12 | 31 |
| 2015 December | 1 | 0 | 1 |
| 2015 October | 0 | 1 | 1 |
| 2015 July | 1 | 0 | 1 |
| 2015 June | 0 | 1 | 1 |
| 2015 April | 3 | 5 | 8 |
| 2015 March | 2 | 7 | 9 |
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