Persistent cow's milk protein intolerance in infants: the changing faces of the same disease.
BACKGROUND
Recent research has shown that cow's milk protein intolerance (CMPI) often persists beyond 4 years of age.


OBJECTIVE
To evaluate the clinical and immunological characteristics of a group of infants with persistent CMPI.


METHODS
Twelve infants (6 m, 6f) with persistent CMPI were followed up from birth until a median age of 5 years. The patients underwent CMP challenge each year to evaluate CMP-tolerance. As controls we followed 26 infants (12 m, 14 f) with CMPI that resolved within 1-2 years.


RESULTS
A family history of atopic disease was found in 10/12 patients with persistent CMPI and in 10/26 controls (P<0.01). Clinical presentation changed over time: at onset symptoms were prevalently gastrointestinal, while at the end of the study there was an increased frequency of wheezing and constipation and a higher frequency of delayed reactions to CMP-challenge than at study commencement (9/12 vs 2/12; P<0.007). 11/12 infants with persistent CMPI and 3/26 controls (P<0.0001) presented multiple food intolerance. During the observation period 9/12 infants with persistent CMPI and 2/26 controls showed atopic disease: asthma, rhinitis, eczema (P < 0.0001).


CONCLUSIONS
Persistent CMPI forms are characterized by: (a) considerable importance of familial atopic disease; (b) change in CMPI manifestations over time and more prolonged delay between CMP consumption and manifestation of symptoms; (c) very high frequency of multiple food intolerance and allergic diseases.
Iacono
G
G
II Divisione di Pediatria, Ospedale Di Cristina, Università di Palermo, Italy.
Cavataio
F
F
Montalto
G
G
Soresi
M
M
Notarbartolo
A
A
Carroccio
A
A
D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016269:Milk Hypersensitivity / Q000276:immunology* / Q000503:physiopathology*; D008894:Milk Proteins / Q000009:adverse effects*; D011852:Radioallergosorbent Test
D007074:Immunoglobulin G; D008894:Milk Proteins; D007073:Immunoglobulin E