Gastrointestinal symptoms and clinical response of infants with cow's milk protein allergy

Abstract

Introduction: Quality of life and nutritional status of infants with cow's milk protein allergy (CMA) can be compromised without a proper diagnosis and treatment. 

Objective: To describe digestive symptoms, family and perinatal history and nutritional status of ≤ 12 month infants with CMA between June 2007 and August 2011. 

Patients and Method: A retrospective and descriptive study in ≤ 12 month old infants suspecting CMA was performed. Family history, perinatal and clinical characteristics were studied. Cases without food test or open challenge test, or whose reason for consultation corresponded to other pathology were excluded. The program STATA 11.1 was used for statistical analysis and p < 0.05 was considered statistically significant. 

Results: 40 infants (57.5 % boys), age 3 ± 0.4 months and history of 2 ± 0.3 months presenting the following: 20 of them (50 %), vomiting/regurgitation; 8 (20 %), bloody diarrhea; 4 (10%) failure to thrive; 4 (10%), colic/irritability and bloody normal deposition was present in 3 individuals (7.5 %). Family and perinatal history: 35 (87.5 %) were bottle-fed during the first week of life; 31 (77.5 %) had ≥ 30 year old mothers; 28 (70 %) described 2 family members (parents/siblings) with atopy; 27 (67.5 %) were delivered via cesarean. At the 14 ± 1.4-month follow-up, 19 (47.5 %) responded to extensively hydrolyzed formula ± breastfeeding; 19 to amino acid formula ± breastfeeding and one patient to breastfeeding exclusively. The Z -score for P/E was: -1.05 ± 1.28; T/E: -0.96 ± 1.60; BMI: -0.61 ± 1.03 in the first consultation; after a year, scores improved: P/E: -0.15 ± 1.24; T/E: -0.29 ± 1.14 and BMI: -0.04 ± 1.20 (p < 0.05), independent from formula (p = NS). 23 (74%) tolerated whole milk when reached a year old. 

Conclusions: In this study, the predominant early symptoms were vomiting, regurgitation and bloody diarrhea. Among the antecedents, early exposure to cow's milk, parental atopy and cesarean delivery were described. With proper treatment, nutritional recovery was observed independent from formula used, and cow's milk tolerance was observed in a high percentage of infants when they reached a year old.