Cow’s Milk Protein Allergy in Children: An Observational Descriptive Retrospective Study

International Journal of Medical Science

© 2024 by SSRG - IJMS Journal

Volume 11 Issue 1

Year of Publication : 2024

Authors : Aria Mohammad, Mohammad Mohammad, Leen Doya, Ali Ibrahim

10.14445/23939117/IJMS-V11I1P106

How to Cite?

Aria Mohammad, Mohammad Mohammad, Leen Doya, Ali Ibrahim, "Cow’s Milk Protein Allergy in Children: An Observational Descriptive Retrospective Study," SSRG International Journal of Medical Science, vol. 11,  no. 1, pp. 30-35, 2024. Crossref, https://doi.org/10.14445/23939117/IJMS-V11I1P106

Abstract:

Background: Cow's Milk Protein Allergy (CMPA) is the most prevalent food allergy in children and is considered challenging to diagnose due to the diverse range of symptoms and lack of definitive tests. Objective: To identify the clinical manifestations of children diagnosed with CMPA and describe the macroscopic and histopathological findings during gastrointestinal endoscopy. Methods: A retrospective observational study was conducted at Tishreen University Hospital in Lattakia, Syria, over four years (2019-2022). The entry criteria were children diagnosed with CMPA. Selected cases underwent upper/lower gastrointestinal endoscopy. A positive result was defined as the presence of eosinophils (approximately 15-20 cells/high power field) in the histopathology while ruling out other potential causes of elevated eosinophils. Results: The study included 103 children. Endoscopic procedures with biopsies were performed in 61 patients. The results showed gastrointestinal symptoms, particularly vomiting, were the most common. General symptoms, such as failure to thrive and iron deficiency anemia, were also prevalent. Macroscopic manifestations of gastritis, such as congestion and edema, were frequently observed during upper gastrointestinal endoscopy. Additionally, 45.5% of cow's milk allergy patients exhibited visual nodular lymphatic hyperplasia during colonoscopy. Elevated eosinophils were found in 77.2% of colon biopsies and 75.4% of duodenal biopsies. Conclusion: This study recommends that conducting gastrointestinal endoscopy is beneficial for diagnosing challenging cases with various symptoms across different systems. Also, diluted gout milk proved an acceptable treatment option for underprivileged parents.

Keywords:

Colonoscopy, Cow's Milk Protein Allergy (CMPA), Upper Gastrointestinal Endoscopy, Failure to Thrive, vomiting.

References:

[1] Joshua A. Boyce et al., “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAIDSponsored Expert Panel,” The Journal of Allergy and Clinical Immunology, vol. 126, no. 6, pp. S1-58, 2010.
[CrossRef] [Google Scholar] [Publisher Link]
[2] Norman F. Carvalho et al., “Severe Nutritional Deficiencies in Toddlers Resulting from Health Food Milk Alternatives,” Pediatrics, vol. 107, no. 4, 2001.
[CrossRef] [Google Scholar] [Publisher Link]
[3] Hugh A. Sampson, “Food Allergy. Part 1: Immunopathogenesis and Clinical Disorders,” Journal of Allergy and Clinical Immunology, vol. 103, no. 5, pp. 717-728, 1999.
[CrossRef] [Google Scholar] [Publisher Link]
[4] Hugh A. Sampson, “Food Allergy. Part 2: Diagnosis and Management,” Journal of Allergy and Clinical Immunology, vol. 103, no. 6, pp. 981-989, 1999.
[CrossRef] [Google Scholar] [Publisher Link]
[5] Sami L. Bahna, “Cow's Milk Allergy Versus Cow Milk Intolerance,” Annals of Allergy, Asthma & Immunology, vol. 89, no. 6, pp. 56- 60, 2002.
[CrossRef] [Google Scholar] [Publisher Link]
[6] Arne Høst, “Frequency of Cow's Milk Allergy in Childhood,” Annals of Allergy, Asthma & Immunology, vol. 89, no. 6, pp. 33-37, 2002.
[CrossRef] [Google Scholar] [Publisher Link]
[7] D.J. Hill et al., “Manifestations of Milk Allergy in Infancy: Clinical and Immunologic Findings,” The Journal of Pediatrics, vol. 109, no. 2, pp. 270-276, 1986.
[CrossRef] [Google Scholar] [Publisher Link]
[8] Antonella Cianferoni, and Jonathan M. Spergel, “Food Allergy: Review, Classification and Diagnosis,” Allergology International, vol. 58, no. 4, pp. 457-466, 2009.
[CrossRef] [Google Scholar] [Publisher Link]
[9] S. Koletzko et al., “Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children,” Journal of Pediatric Gastroenterology and Nutrition, vol. 55, no. 2, pp. 221-229, 2012.
[CrossRef] [Google Scholar] [Publisher Link]
[10] Kevin J. Kelly et al., “Eosinophilic Esophagitis Attributed to Gastroesophageal Reflux: Improvement with an Amino Acid-Based Formula,” Gastroenterology, vol. 109, no. 5, pp. 1503-1512, 1995.
[CrossRef] [Google Scholar] [Publisher Link]
[11] Elena Tataranu et al., “Clinical, Immunological and Pathological Profile of Infants Suffering from Cow's Milk Protein Allergy,” Romanian Journal of Morphology and Embryology, vol. 57, no. 3, pp. 1031-1035, 2016.
[Google Scholar] [Publisher Link]
[12] I. Jakobsson, and T. Lindberg, “A Prospective Study of Cow's Milk Protein Intolerance in Swedish Infants,” Acta Paediatrica, vol. 68, no. 6, pp. 853-859, 1979.
[CrossRef] [Google Scholar] [Publisher Link]
[13] Mladenović Marija et al., “Clinical Manifestations of Cow Milk Protein Intolerance in Infants,” Serbian Archive for All Medicine, vol. 133, no. 7-8, pp. 348-352, 2005.
[CrossRef] [Google Scholar] [Publisher Link]
[14] R. Cervantes-Bustamante et al., “Histopathologic Findings in Children Diagnosed with Cow's Milk Protein Allergy,” Journal of Gastroenterology of Mexico, vol. 80, no. 2, pp. 130-134, 2015.
[CrossRef] [Google Scholar] [Publisher Link]
[15] Ujjal Poddar et al., “Cow's Milk Protein Allergy: An Entity for Recognition in Developing Countries,” Journal of Gastroenterology Hepatology, vol. 25, no. 1, pp. 178-182, 2010.
[CrossRef] [Google Scholar] [Publisher Link]
[16] J.J.P. Schrander et al., “Cow's Milk Protein Intolerance in Infants Under 1 Year of Age: A Prospective Epidemiological Study,” European Journal of Pediatrics, vol. 152, no. 8, pp. 640-644, 1993.
[CrossRef] [Google Scholar] [Publisher Link]
[17] M.D. Giuseppe Lacono et al., “Gastroesophageal Reflux and Cow's Milk Allergy in Infants: A Prospective Study,” Journal of Allergy and Clinical Immunology, vol. 97, no. 3, pp. 822-827, 1996.
[CrossRef] [Google Scholar] [Publisher Link]
[18] H.S. Winter et al., “Allergy-Related Proctocolitis in Infants: Diagnostic Usefulness of Rectal Biopsy,” Modern Pathology, vol. 3, no. 1, pp. 5-10, 1990.
[Google Scholar] [Publisher Link]
[19] Yvan Vandenplas et al., “An ESPGHAN Position Paper on the Diagnosis, Management and Prevention of Cow's Milk Allergy,” Journal of Pediatric Gastroenterology and Nutrition, vol. 78, no. 2, pp. 386-413, 2024.
[CrossRef] [Google Scholar] [Publisher Link]
[20] María Catalina Bagés et al., “Expert Recommendations for Diagnosis and Treatment of Cow’s Milk Protein Allergy in the Colombian Pediatric Population,” Colombian Journal of Gastroenterology, vol. 35, no. 1, pp. 54-56, 2020.
[Google Scholar]
[21] Kirsi M. Järvinen, and Pantipa Chatchatee, “Mammalian Milk Allergy: Clinical Suspicion, Cross-Reactivities and Diagnosis,” Current Opinion in Allergy and Clinical Immunology, vol. 9, no. 3, pp. 251-258, 2009.
[CrossRef] [Google Scholar] [Publisher Link]