Eosinophilic Esophagitis, Eosinophilic Gastrointestinal Disorders (EGIDs)
Conditions
Brief summary
The purpose of this interventional study is to test and compare the effectiveness of two elimination diets-the 1-food elimination diet (1FED, milk only) and the 4-food elimination diet (4FED, milk, egg, wheat, and soy) for eosinophilic esophagitis (EoE). The study will also test the effectiveness of swallowed glucocorticoid therapy in some of the study participants for whom diet therapy was not effective.
Detailed description
This study will consist of two phases, plus a screening period. During the screening period, subject eligibility for the study will be determined. During Phase 1, qualified participants will be randomly assigned to one of two elimination diet therapies--the 1FED or the 4FED. Participants will remain on the assigned dietary therapy for 12 weeks. At the end of 12 weeks of therapy, esophageal biopsies from participant's standard of care (i.e. normal, routine care) endoscopy will be evaluated to determine disease status. Participants whose EoE is in remission (i.e. \<15 eos/hpf) will be done with the study. Participants whose EoE is still active (i.e. ≥15 eos/hpf) will continue into Phase 2 of the study. During Phase 2, participants who were on 1FED in Phase 1 will receive 4FED therapy for 12 weeks, and participants who were on 4FED during Phase 1 will receive swallowed glucocorticoid therapy for 12 weeks. At the end of 12 weeks of therapy, esophageal biopsies from participant's standard of care (i.e. normal, routine care) endoscopy will be evaluated to determine disease status.
Interventions
Participants eliminate milk from the diet for 12 weeks
Participants eliminate milk, egg, wheat, soy from the diet for 12 weeks
Participants that fail to respond to 1FED in phase 1 eliminate milk, egg, wheat, soy from the diet for 12 weeks in Phase 2
Participants that fail to respond to 4FED in phase 1 administer swallowed glucocorticosteroids (Flovent HFA) 800 mcg twice daily for 12 weeks in Phase 2
Sponsors
Study design
Eligibility
Inclusion criteria
* Have diagnosis of EoE (based on consensus criteria) * Are aged 6 to 17 years * Have histologically confirmed active disease \>15 eosinophils/hpf in either distal or proximal esophagus within 12 weeks of screening visit * Proton Pump Inhibitor (PPI) confirmation * Symptomatic (have experienced symptoms within the last month prior to enrollment) * Has a negative urine pregnancy test at screening if of childbearing potential. Females of childbearing potential must have a negative urine pregnancy test (β-hCG) prior to enrollment into the study (i.e., at screening). Subsequently, these participants must agree to use adequate birth control measures (e.g., condom, oral/injectable/subcutaneous contraceptives, intrauterine device, or sexual abstinence) during the study and for at least one month after the last dose of study drug which will be documented in the source documents.
Exclusion criteria
* Have been treated with topical swallowed steroids within the last 2 months or systemic steroids within the past 3 months * Have eosinophilia in segments of the GI tract other than the esophagus * Have been diagnosed with a GI malabsorption disorder (i.e., Inflammatory bowel disease, Crohn's disease) or Celiac disease * Are currently on dietary therapy avoiding milk * Have concurrent H pylori gastritis or parasitic infection * Are unable to obtain esophagogastroduodenoscopy with esophageal biopsies at Cincinnati Children's Hospital Medical Center (CCHMC) or other participating institution within 4 weeks of study completion * Have previously failed (in a clinical trial setting) dietary therapy with one of these regimens or topical steroid treatment with fluticasone at a total dose of 1760 mcg per day. * Have definitely responded (in a clinical trial setting) to either dietary therapy avoiding these antigens or to swallowed fluticasone at a total dose of 1760 mcg per day * Are concurrently receiving any of the prohibited medications listed in Table 2 * On immunotherapy for pollen (if not on maintenance therapy) or immunoglobulin E (IgE)-mediated food allergy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Pediatric EoE Symptom Score Version 2.0 (PEESS V2.0) at 12 Weeks | Baseline and 12 weeks | The PEESS V2.0 questionnaire captures EoE-specific symptoms (dysphagia, gastro-esophageal reflux disease (GERD), nausea/vomiting, and pain) as reported by children with EoE (8-18 years of age) and their parents (for children 2-18 years of age). The range for PEESS v2.0 scores is 0 to 100, with a higher score being indicative of more frequent and/or severe symptoms. Scores were obtained at baseline and 12 weeks. Change in score is defined as total score at 12 weeks minus total score at baseline. The parent-proxy PEESS total score change from pre-treatment to post-treatment is the primary efficacy endpoint. 1FED vs 4FED changes are compared. A reduction in score (negative change) is indicative of a reduction in symptoms. |
| Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores | Baseline and 12 weeks | The PEESS V2.0 questionnaire captures EoE-specific symptoms. The range for PEESS v2.0 scores is 0 to 100, with a higher score being indicative of more frequent and/or severe symptoms. Baseline vs Week 12 scores are compared within each treatment group (1FED and 4FED). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of 1FED Non-responders on 4FED in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | 12 weeks | Percent of 1FED non-responders on 4FED in histologic remission in phase 2. Remission is defined as esophageal peak eosinophil count \< 15 eosinophils per high powered field. Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf. |
| Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks | Baseline and 12 weeks | The PedsQL 3.0 EoE measures symptoms and problems related to treatment, worry, communication, food/eating, and feelings. The range for PedsQL 3.0 EoE scores is 0 to 100, with a higher score indicating better quality of life. Scores were obtained at baseline and 12 weeks. Change in score is defined as the PedsQL 3.0 EoE total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. An increase in score (positive change) is indicative of improved quality of life. |
| Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | 12 weeks | Percent of participants in remission in 1FED and 4FED groups. Remission is defined as clinical esophageal peak eosinophil count \< 15 eosinophils per high power field (eos/hpf). Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf. |
| Change From Baseline in Endoscopic Reference Score at 12 Weeks | Baseline and 12 weeks | The EoE Endoscopic Reference Score (EREFS) measures features of EoE including esophageal edema, rings, exudate, furrows, and strictures. The instrument grades edema and furrows as absent (0) or present (1); rings as absent (0), mild (1, subtle circumferential ridges), moderate (2, distinct rings) and severe (3, rings that impair passage of a standard adult diagnostic endoscope); exudates as absent (0), mild (1, less than 10% of the esophageal surface area) or severe (2, greater or equal to 10% of the esophageal surface area); and strictures as absent (0) or present (1) with an estimation of the minimal luminal diameter. Higher scores indicate more severe disease (range 0 - 9). Scores were obtained at baseline and 12 weeks. Change in score is defined as the EREFS total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. A reduction in score (negative change) is indicative of a reduction in esophageal abnormalities. |
| Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED | Baseline and 12 weeks | Reactions to skin prick test (SPT) to milk is positive if the wheal size of the milk test is at least 3 mm larger than the wheal size of the negative control. Treatment response is defined as clinical histologic remission (\<15 eos/hpf). |
| Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks | Baseline and 12 weeks | The PedsQL 4.0 measures physical and psychosocial function. The range for PedsQL 4.0 scores is 0 to 100, with a higher score indicating better quality of life. Scores were obtained at baseline and 12 weeks. Change in score is defined as the PedsQL 4.0 total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. An increase in score (positive change) is indicative of improved quality of life. |
| Percent of Participants on Swallowed Glucocorticoids (SGC) in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | 12 weeks | Percent of 4FED non-responders on SGC in Phase 2 in histologic remission. Remission is defined as esophageal peak eosinophil count \< 15 eosinophils per high power field (eos/hpf). Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited from eosinophilic esophagitis (EoE) specialty clinics (10 sites) in the USA between November 2015 and February 2018.
Pre-assignment details
67 participants screened, 4 excluded (2 did not meet inclusion criteria, 2 met exclusion criteria), and 63 randomized
Participants by arm
| Arm | Count |
|---|---|
| 1FED 1-food elimination diet: participants eliminate milk from the diet for 12 weeks | 38 |
| 4FED 4-food elimination diet: participants eliminate milk, egg, wheat, soy from the diet for 12 weeks | 25 |
| Total | 63 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Phase 1 | Lost to Follow-up | 2 | 1 | 0 | 0 |
| Phase 1 | Physician Decision | 0 | 1 | 0 | 0 |
| Phase 1 | Withdrawal by Subject | 2 | 6 | 0 | 0 |
| Phase 2 | Lost to Follow-up | 0 | 0 | 2 | 0 |
| Phase 2 | Physician Decision | 0 | 0 | 0 | 2 |
| Phase 2 | Pregnancy | 0 | 0 | 0 | 1 |
| Phase 2 | Withdrawal by Subject | 0 | 0 | 9 | 3 |
Baseline characteristics
| Characteristic | 4FED | Total | 1FED |
|---|---|---|---|
| Age, Continuous | 12.1 Years STANDARD_DEVIATION 3.7 | 12.2 Years STANDARD_DEVIATION 3.3 | 12.3 Years STANDARD_DEVIATION 3.1 |
| Atopy Atopic | 19 Participants | 53 Participants | 34 Participants |
| Atopy Not Atopic | 6 Participants | 10 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 7 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 21 Participants | 54 Participants | 33 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants | 5 Participants | 4 Participants |
| Race/Ethnicity, Customized Other | 2 Participants | 3 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 22 Participants | 55 Participants | 33 Participants |
| Sex: Female, Male Female | 9 Participants | 21 Participants | 12 Participants |
| Sex: Female, Male Male | 16 Participants | 42 Participants | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 38 | 0 / 25 | 0 / 19 | 0 / 10 |
| other Total, other adverse events | 5 / 38 | 8 / 25 | 6 / 19 | 6 / 10 |
| serious Total, serious adverse events | 1 / 38 | 1 / 25 | 0 / 19 | 0 / 10 |
Outcome results
Change From Baseline in Pediatric EoE Symptom Score Version 2.0 (PEESS V2.0) at 12 Weeks
The PEESS V2.0 questionnaire captures EoE-specific symptoms (dysphagia, gastro-esophageal reflux disease (GERD), nausea/vomiting, and pain) as reported by children with EoE (8-18 years of age) and their parents (for children 2-18 years of age). The range for PEESS v2.0 scores is 0 to 100, with a higher score being indicative of more frequent and/or severe symptoms. Scores were obtained at baseline and 12 weeks. Change in score is defined as total score at 12 weeks minus total score at baseline. The parent-proxy PEESS total score change from pre-treatment to post-treatment is the primary efficacy endpoint. 1FED vs 4FED changes are compared. A reduction in score (negative change) is indicative of a reduction in symptoms.
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1FED | Change From Baseline in Pediatric EoE Symptom Score Version 2.0 (PEESS V2.0) at 12 Weeks | -14.3 units on a scale | Standard Deviation 17.1 |
| 4FED | Change From Baseline in Pediatric EoE Symptom Score Version 2.0 (PEESS V2.0) at 12 Weeks | -21.6 units on a scale | Standard Deviation 17.3 |
Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores
The PEESS V2.0 questionnaire captures EoE-specific symptoms. The range for PEESS v2.0 scores is 0 to 100, with a higher score being indicative of more frequent and/or severe symptoms. Baseline vs Week 12 scores are compared within each treatment group (1FED and 4FED).
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1FED | Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores | Week 12 - Total Score | 23.5 units on a scale | Standard Deviation 18.3 |
| 1FED | Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores | Baseline - Total Score | 38.1 units on a scale | Standard Deviation 14.2 |
| 4FED | Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores | Baseline - Total Score | 42.9 units on a scale | Standard Deviation 16 |
| 4FED | Within-group Comparisons (Baseline v. Week 12) of PEESS V2.0 Scores | Week 12 - Total Score | 16.0 units on a scale | Standard Deviation 13 |
Change From Baseline in Endoscopic Reference Score at 12 Weeks
The EoE Endoscopic Reference Score (EREFS) measures features of EoE including esophageal edema, rings, exudate, furrows, and strictures. The instrument grades edema and furrows as absent (0) or present (1); rings as absent (0), mild (1, subtle circumferential ridges), moderate (2, distinct rings) and severe (3, rings that impair passage of a standard adult diagnostic endoscope); exudates as absent (0), mild (1, less than 10% of the esophageal surface area) or severe (2, greater or equal to 10% of the esophageal surface area); and strictures as absent (0) or present (1) with an estimation of the minimal luminal diameter. Higher scores indicate more severe disease (range 0 - 9). Scores were obtained at baseline and 12 weeks. Change in score is defined as the EREFS total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. A reduction in score (negative change) is indicative of a reduction in esophageal abnormalities.
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1FED | Change From Baseline in Endoscopic Reference Score at 12 Weeks | Baseline - Total Score | 2.5 units on a scale | Standard Deviation 1.3 |
| 1FED | Change From Baseline in Endoscopic Reference Score at 12 Weeks | Change from Baseline to Week 12 | -0.7 units on a scale | Standard Deviation 2.2 |
| 4FED | Change From Baseline in Endoscopic Reference Score at 12 Weeks | Baseline - Total Score | 3.3 units on a scale | Standard Deviation 1.8 |
| 4FED | Change From Baseline in Endoscopic Reference Score at 12 Weeks | Change from Baseline to Week 12 | -1.3 units on a scale | Standard Deviation 2.2 |
Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks
The PedsQL 3.0 EoE measures symptoms and problems related to treatment, worry, communication, food/eating, and feelings. The range for PedsQL 3.0 EoE scores is 0 to 100, with a higher score indicating better quality of life. Scores were obtained at baseline and 12 weeks. Change in score is defined as the PedsQL 3.0 EoE total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. An increase in score (positive change) is indicative of improved quality of life.
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1FED | Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks | Baseline - Total Score | 71.3 units on a scale | Standard Deviation 13 |
| 1FED | Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks | Change from Baseline to Week 12 | 9.7 units on a scale | Standard Deviation 11.3 |
| 4FED | Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks | Baseline - Total Score | 67.5 units on a scale | Standard Deviation 13.6 |
| 4FED | Change From Baseline in Pediatric Quality of Life Inventory Version 3.0 EoE Module (PedsQL 3.0 EoE) at 12 Weeks | Change from Baseline to Week 12 | 9.8 units on a scale | Standard Deviation 14.1 |
Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks
The PedsQL 4.0 measures physical and psychosocial function. The range for PedsQL 4.0 scores is 0 to 100, with a higher score indicating better quality of life. Scores were obtained at baseline and 12 weeks. Change in score is defined as the PedsQL 4.0 total score at 12 weeks minus total score at baseline. 1FED vs 4FED changes are compared. An increase in score (positive change) is indicative of improved quality of life.
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1FED | Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks | Baseline - Total Score | 80.3 units on a scale | Standard Deviation 10.8 |
| 1FED | Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks | Change from Baseline to Week 12 | 3.7 units on a scale | Standard Deviation 9.9 |
| 4FED | Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks | Baseline - Total Score | 79.9 units on a scale | Standard Deviation 14.5 |
| 4FED | Change From Baseline in Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales at 12 Weeks | Change from Baseline to Week 12 | 5.3 units on a scale | Standard Deviation 16.4 |
Percent of 1FED Non-responders on 4FED in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2
Percent of 1FED non-responders on 4FED in histologic remission in phase 2. Remission is defined as esophageal peak eosinophil count \< 15 eosinophils per high powered field. Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf.
Time frame: 12 weeks
Population: We performed Intent to treat analysis including participants who had at least one clinical observation post randomization.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 1FED | Percent of 1FED Non-responders on 4FED in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Complete remission (≤ 1 eos/hpf) | 0 percentage of participants |
| 1FED | Percent of 1FED Non-responders on 4FED in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Partial remission (2 - 14 eos/hpf) | 12.5 percentage of participants |
| 1FED | Percent of 1FED Non-responders on 4FED in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Remission (< 15 eos/hpf) | 12.5 percentage of participants |
Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks
Percent of participants in remission in 1FED and 4FED groups. Remission is defined as clinical esophageal peak eosinophil count \< 15 eosinophils per high power field (eos/hpf). Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf.
Time frame: 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 1FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Complete remission (≤ 1 eos/hpf) | 20.6 percentage of participants |
| 1FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Partial remission (2 - 14 eos/hpf) | 23.5 percentage of participants |
| 1FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Remission (< 15 eos/hpf) | 44.1 percentage of participants |
| 4FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Complete remission (≤ 1 eos/hpf) | 17.6 percentage of participants |
| 4FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Partial remission (2 - 14 eos/hpf) | 23.5 percentage of participants |
| 4FED | Percent of Participants in Histologic Remission (<15 Eosinophils Per High Power Field) at 12 Weeks | Remission (< 15 eos/hpf) | 41.2 percentage of participants |
Percent of Participants on Swallowed Glucocorticoids (SGC) in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2
Percent of 4FED non-responders on SGC in Phase 2 in histologic remission. Remission is defined as esophageal peak eosinophil count \< 15 eosinophils per high power field (eos/hpf). Complete remission is defined as ≤ 1 peak eos/hpf and partial remission as 2 - 14 peak eos/hpf.
Time frame: 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 1FED | Percent of Participants on Swallowed Glucocorticoids (SGC) in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Complete remission (≤ 1 eos/hpf) | 25.0 percentage of participants |
| 1FED | Percent of Participants on Swallowed Glucocorticoids (SGC) in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Partial remission (2 - 14 eos/hpf) | 25.0 percentage of participants |
| 1FED | Percent of Participants on Swallowed Glucocorticoids (SGC) in Histologic Remission (<15 Eos/Hpf) at 12 Weeks in Phase 2 | Remission (< 15 eos/hpf) | 50.0 percentage of participants |
Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED
Reactions to skin prick test (SPT) to milk is positive if the wheal size of the milk test is at least 3 mm larger than the wheal size of the negative control. Treatment response is defined as clinical histologic remission (\<15 eos/hpf).
Time frame: Baseline and 12 weeks
Population: We performed intent to treat analysis including participants who had at least one clinical observation post randomization
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 1FED | Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED | Percent of total with positive milk SPT | 11 percentage of participants |
| 1FED | Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED | Percent of total with negative milk SPT | 89 percentage of participants |
| 1FED | Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED | Percent with positive SPT responding to 1FED | 33 percentage of participants |
| 1FED | Percent of Participants With Positive and Negative Milk Skin Prick Tests Responding to 1FED | Percent with negative SPT responding to 1FED | 48 percentage of participants |