Gastrointestinal manifestations of cow's milk protein allergy
during the first year of life.
Yimyaem P, Chongsrisawat V, Vivatvakin B, Wisedopas N.
Gastroenterology Division, Department of Pediatrics, Faculty of Medicine,
Chulalongkorn University, Bangkok 10330, Thailand.
BACKGROUND: Cow's milk protein sensitive enteropathy (CMPSE) is a common
condition in the first year of life. Clinically CMPSE usually presents with
symptoms like vomiting, chronic diarrhea, mucous bloody diarrhea and
hematemesis. More unusual symptoms associated with CMPSE are infantile colic,
gastroesophageal reflux and chronic constipation. The objective of this study
was to assess the gastrointestinal manifestations and allergic march in CMPSE
patients. METHOD: The authors reviewed the records of 10 CMPSE patients observed
by the Gastrointestinal Unit at King Chulalongkorn Memorial Hospital from
1997-2001 including patient characteristics, laboratory investigations,
endoscopy and follow-up outcome. RESULTS: Of 10 CMPSE patients, the median age
of CMPSE onset was 3.5 months. The gastrointestinal manifestations were
hematemesis (n = 6), mucous bloody diarrhea (n = 3) and chronic watery diarrhea
(n = 2). Exclusively breast-fed infants seemed to have more delayed onset of
symptoms than those who were not. Anemia (n = 3), high serum IgE (n = 4) and
positive skin prick test for cow's milk (n = 5) were found. Neither peripheral
eosinophilia nor hypoalbuminemia was found. Endoscopy revealed acute and chronic
gastritis. Treatment was successful by changing to soy or extensive hydrolysate
formula with mean duration of cow's milk intolerance of 24 months. In 2-year
follow-up, three of ten patients who had high serum IgE level developed allergic
rhinitis and eczema. CONCLUSION: CMPSE can be manifested in various symptoms.
Exclusive breast feeding for more than 4 months can postpone the onset of CMPSE.
Serum IgE or specific IgE level to cow's milk protein may identify the atopic
career of CMPSE individuals.
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