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P30 Why is cow’s milk protein allergy diagnosis so difficult in infants with gastrointestinal symptoms?
  1. Mirela Stocklosa,
  2. Raluca Vlad,
  3. Alexandra Moraru,
  4. Irina Dijmarescu,
  5. Ioana Oprescu,
  6. Cristina Becheanu,
  7. Daniela Pacurar,
  8. Dumitru Oraseanu,
  9. Gabriela Lesanu
  1. Gastroenterology Department, ‘Grigore Alexandrescu’ Emergency Children’s Hospital, Bucharest, Romania

Abstract

Background and aims Current research reveals an increasing prevalence of cow’s milk protein allergy (CMPA). We aimed to evaluate infants with gastrointestinal symptoms and the consequent diagnosis of CMPA in a Romanian paediatric population.

Methods Authors report partial results (July 2014-November 2016) of an on-going prospective study conducted in the Gastroenterology Department of ‘Grigore Alexandrescu’ Emergency Children’s Hospital, Bucharest. Children aged≤12 month with gastrointestinal symptoms suggestive for CMPA were included (persistent diarrhoea, bloody stools, loose mucous stools, recurrent vomiting, food refusal, constipation, abdominal pain). All underwent clinical evaluation, blood work-up, exclusion diet and for those without immediate reaction a oral food challenge (OFC) was done.

Results Our study included 139 infants with symptoms suggesting CMPA. We excluded 87 patients: 7 infants didn’t respond to exclusion diet, 11 of them had negative OFC and the rest of 69 didn’t have an OFC (parents refused, had growth impairment or were lost from follow-up). 52 children were consequently diagnosed with CMPA following ESPGHAN guidelines. Median age at onset of symptoms was 3 months. 92% of infants came from urban areas. Sex ratio M/F=0.9. One third of the patients had a first-degree sibling with allergy. Only 37.5% were exclusively breastfeed until 4 month. Growth impairment was noted in 42.3% of cases. The most frequent presenting symptoms were loose mucous stool (46%), recurrent vomiting (28.8%), regurgitation (28.8%), food refusal (25%), bloody stools (23%). Cutaneous manifestations (urticaria, atopic eczema) were associated in 88.4% of patients. Specific IgEs were positive in 44.2% of patients. 15.3% of infants associated another food allergy (mostly eggs allergy).

Conclusions CMPA remains a challenge for the paediatrician. Gastrointestinal symptoms are non-specific. However, associated cutaneous manifestations may be an usefull clinical indicator of CMPA. The gold standard in diagnosing CMPA remains OFC, which in daily practice is underused.

  • cow’s milk protein allergy
  • gastrointestinal symptoms
  • infants

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