Clinical Outcome of Infants and Children Diagnosed with Cow Milk Allergy 3years after Reintroduction of Cow Milk Products

Abstract

The present study was carried to evaluate the clinical outcome of Cow’s milk protein allergy (CMPA) in patients diagnosed with CMPA 3 years after introduction of cow milk product who presented to the Ain Shams Pediatric Gastroenterology Unit (ASPU), Children Hospital, Ain Shams University 3years October 2012and February 2014. The study included 50 cases, they were24 males (48%) and 26 females (52%) Their ages ranged from 3.5to 6.5 years with a mean age of 4.98± 0.70 compared to 50 age matched controls with no history of CMPA The diagnosis of CMP was based on clinical history, skin tests, biological tests and oral food challenges All patients had medical history taking, with special emphasis on gastrointestinal symptoms (vomiting, diarrhea, constipation, bleeding per rectum), associated extra intestinal symptoms (wheezing, cough, atopic dermatitis, eczema, itching, allergic rhinitis and weight loss), family history of atopy, duration of elimination and type of alternative formula. Careful clinical examination was done with special emphasis on, weight, skin allergy, abdominal examination (distension, tenderness, rigidity and organomegaly) and anthropometric measures; (weight for age and length for age in terms of Z score value). All patients had a laboratory assessment of CBC (hemoglobin %, platelet count and TLC), and serum IgE against whole cow's milk protein (by RAST), The present study revealed that vomiting was reported by 66% of cases at time of diagnosis, diarrhea among60%of the cases, constipation among 28% of cases, and bleeding per rectum among 18%of cases at time of diagnosis. Regarding the extra intestinal manifestations the present study revealed the presence of failure to thrive among 36% of cases at time of diagnosis, atopic dermatitis among 26% of cases, urticaria among 16% of cases, angioedema among 4% of cases, allergic rhinitis among 14%of cases, wheezing among 6%of cases, and cough among 20% of cases at time of diagnosis. 3 years after introduction of cow milk product in cases diagnosed with CMPA the present study shows there is significant increase in occurrence of chronic diarrhea among cases 16%compared to controls 2%, on the other hand there is no significant difference between cases and controls regarding current symptoms of vomiting, constipation, and bleeding per rectum.