Gastrointestinal manifestations of cow's milk protein allergy during the first year of life.
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.


METHODS
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.


CONCLUSIONS
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.
Yimyaem
Phisek
P
Gastroenterology Division, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Chongsrisawat
Voranush
V
Vivatvakin
Boosba
B
Wisedopas
Naruemon
N
D017677:Age Distribution; D000818:Animals; D001707:Biopsy, Needle; D002417:Cattle; D005753:Gastric Mucosa / Q000276:immunology / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology*; D008894:Milk Proteins / Q000009:adverse effects*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013785:Thailand / Q000453:epidemiology
D008894:Milk Proteins