Clinical Observations of Gastrointestinal Cow Milk Allergy in Children According to a New Classification.
- Author:
Jin Bok HWANG
1
;
Seon Yun CHOI
;
Tae Chan KWON
;
Hoon Kyu OH
;
Sin KAM
Author Information
1. Department of Pediatrics, Keimyung University School of Medicine, Korea. pedgi@korea.com
- Publication Type:Original Article
- Keywords:
Food allergy;
Gastrointestinal cow milk allergy;
Cow milk protein-induced enterocolitis;
Eosinophilic gastroenterocolitis;
Cow milk protein proctitis;
Gastroesophageal reflux-associated cow milk allergy;
Cow milk protein-induced enteropathy;
IgE-mediated cow milk allergy
- MeSH:
Birth Weight;
Body Weight;
Child*;
Classification*;
Diagnosis;
Enterocolitis;
Eosinophils;
Food Hypersensitivity;
Humans;
Immunoglobulin E;
Infant;
Milk Hypersensitivity*;
Milk Proteins;
Milk*;
Proctitis
- From:Korean Journal of Pediatric Gastroenterology and Nutrition
2004;7(1):40-47
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: A new classification of gastrointestinal food allergy was published, but the changes of terminology between previously reported terms and the new ones were in a state of disorder. This has resulted in confusion between medical communication and diagnostic and therapeutic approaches. The clinical observations of infants presenting with gastrointestinal cow milk allergy (GI-CMA) were performed, and the changes in the terminology reviewed through the published Korean literature. METHODS: Between March 2003 and July 2003, data from 37 consecutive infants with GI-CMA, aged 2 weeks to 15 months, were reviewed. The challenge and elimination test of cow milk, and the endoscopic and histologic findings, were used for the seven subdivisions of GI-CMA according to a new classification on the basis of patients' ages, clinical manifestations and location of gastrointestinal lesions. RESULTS: The 37 patients had a mean age of 5.4+/-4.8 months, with those observed in 26 (70.3%) of patients being below 6 months of age. The seven final diagnoses were; cow milk protein-induced enterocolitis (CMPIE) in 12 (32.4%), cow milk protein proctitis (PROC) in 12 (32.4%), IgE-mediated (IGE) in 6 (16.2%), gastroesophageal reflux-associated cow milk allergy (GERA) in 5 (13.5%) and eosinophilic gastroenterocolitis in 2 (5.4%). CMPIE was revealed as the typical type in 7 (18.9%) and the atypical type in 5 (13.5%), and all of typical CMPIE revealed cow milk protein-induced enteropathy. The mean age at symptom onset was 4.3+/-0.8 months, and for those with typical and atypical CMPIE, and PROC and GERA were 3.8+/-4.6, 10.4+/-3.8, 3.4+/-3.9 and 7.8+/-5.7 months, respectively (p<0.05). The period from onset of symptom to diagnosis was 2.4+/-3.3 (0.5~12) months, with those observed in atypical CMPIE and GERA being over 3months. Although the birth weights in all patients were within the 10~90 percentile range, the body weights on diagnoses were below the 3 percentile in 48.6%; IGE 16.7%, EOS 0%, typical CMPIE 85.7%, atypical CMPIE 60.0%, PROC 25.0% and GERA 100% (p<0.05). Through the review of the Korean literature, 8 case reports and 14 original articles for GI-CMA were found. CONCLUSION: GI-CMA is not a rare clinical disorder and is subdivided into seven categories on the basis of the patient's age, clinical manifestations and location of the gastrointestinal lesions. The terms for GI-CMA are changing with new classifications, and careful approaches are necessary for medical communications.
