title: [Case report: allergy to cow's milk protein].
abstract: OBJECTIVE
  Milk-based formulas can induce cow’s milk protein allergy (CMPA) in infants. This article discusses two cases of severe CMPA in infants exposed to casein-based formulas.
  
  
  METHODS
  Case N°1: A 7 day old boy developed diarrhea with no improvement despite several courses of antibiotic and switching to formula without lactose. At 2 months of age he had a hemoglobin 8.6 mg/dL, IgE = 17.8 IU/ml (normal <1.5 UI/ml) and a CD4/CD8 ratio = 0.16 (normal 1.5 – 2.5). Upper endoscopy biopsies showed duodenal atrophy. He received a casein hydrolysate formula with decreased fecal flow but continued diarrhea. At 3 months of life he was changed to an amino acid formula with cessation of diarrhea in < 48 hours, resumption of normal growth and normalization of duodenal histology. Case N°2: A 10 month old boy had a 6-day history of vomiting, diarrhea and edema. His albumin was 2.35 mg/dL. An upper endoscopy biopsy showed severe duodenal atrophy. He received a casein hydrolysate with good tolerance and resolution of the edema. At 26 months of age, and endoscopic duodenal biopsy showed regeneration of the mucosa.
  
  
  CONCLUSIONS
  The CMPA is a frequent diagnosis in young infants that can be confused with infection. An early diagnosis is key to a positive outcome.
authors.affiliation: Gastroenterólogo Pediatra, Unidad de Gastropediatría, Servicio de Pediatría Especializada. Hospital Nacional Edgardo Rebagliati Martins. Lima – Perú.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñoz Urribarri
authors.forename: Alex
authors.initials: A
authors.lastname: Delgado Godos
authors.forename: Raúl
authors.initials: R
authors.lastname: Castillo Durán
authors.forename: Alejandro
authors.initials: A
authors.lastname: Yábar Berrocal
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage; D000818:Animals; D001284:Atrophy; D001706:Biopsy; D001942:Breast Feeding; D002241:Carbohydrates / Q000008:administration & dosage; D002364:Caseins / Q000009:adverse effects*; D002417:Cattle; D003937:Diagnosis, Differential; D003968:Diarrhea, Infantile / Q000209:etiology; D004041:Dietary Fats / Q000008:administration & dosage; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D007787:Lactose Intolerance / Q000175:diagnosis; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000209:etiology*
chemical_list: D000596:Amino Acids; D002241:Carbohydrates; D002364:Caseins; D004041:Dietary Fats; C076533:Neocate; C475729:casein hydrolysate