Nelly Rajuan

Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy.

BACKGROUND The diversity in the perceived prevalence, recovery, and risk factors for cows milk allergy (CMA) necessitated a large-scale, population-based prospective study. OBJECTIVE We sought to determine the prevalence, cross-reactivity with soy allergy, and risk factors for the development of CMA. METHODS In a prospective study the feeding history of 13,019 infants was obtained by means of telephone interview (95.8%) or questionnaire (4.2%). Infants with probable adverse reactions to milk were examined, skin prick tested, and challenged orally. RESULTS Ninety-eight percent of the cohort participated in the study. The cumulative incidence for IgE-mediated CMA was 0.5% (66/13,019 patients). The mean age of cows milk protein (CMP) introduction was significantly different (P < .001) between the healthy infants (61.6 +/- 92.5 days) and those with IgE-mediated CMA (116.1 +/- 64.9 days). Only 0.05% of the infants who were started on regular CMP formula within the first 14 days versus 1.75% who were started on formula between the ages of 105 and 194 days had IgE-mediated CMA (P < .001). The odds ratio was 19.3 (95% CI, 6.0-62.1) for development of IgE-mediated CMA among infants with exposure to CMP at the age of 15 days or more (P < .001). Sixty-four patients with IgE-mediated CMA tolerated soy, and none had a proved allergy to soy. CONCLUSIONS IgE-mediated CMA is much less common than generally reported. Early exposure to CMP as a supplement to breast-feeding might promote tolerance. Finally, soy is a reasonable feeding alternative in patients with IgE-mediated CMA.

The prevalence and natural course of food protein–induced enterocolitis syndrome to cow’s milk: A large-scale, prospective population-based study

BACKGROUND The prevalence and natural history for food protein-induced enterocolitis syndrome (FPIES) have not been determined. OBJECTIVE We sought to determine the prevalence, clinical manifestations, and rate of recovery for FPIES in a large-scale, population-based prospective study. METHODS In a prospective study the feeding history of 13,019 infants was obtained. Infants with probable adverse reactions to cows milk protein (CMP) were clinically examined, skin prick tested, and challenged orally. Diagnostic criteria for CMP-induced FPIES included age less than 9 months, delayed recurrent vomiting (usually with nausea), and lethargy after exposure to CMP in the absence of other IgE-mediated symptoms, such as rash, urticaria, and respiratory symptoms. In addition, a positive challenge response to milk resulted in the above-mentioned gastrointestinal symptoms, removal of milk from the diet resulted in the resolution of those symptoms, or both. RESULTS Ninety-eight percent of the cohort participated in the study. The cumulative incidence for FPIES was 0.34% (44/13,019 patients). The most common symptoms were recurrent vomiting (100%), lethargy (77%) diarrhea (25%), pallor (14%), and bloody diarrhea (4.5%). All patients had FPIES within the first 6 months of life. By the age of 3 years, 90% of the patients had recovered. We did not detect any concomitant reaction to soy. Eight patients with FPIES had IgE-mediated cows milk allergy (IgE-CMA). CONCLUSIONS The prevalence of FPIES is significant, and its clinical presentation is distinct from that of IgE-CMA. Most patients with FPIES recover, although a proportion might convert to IgE-CMA. The likelihood for a cross-reactivity to soy in this population was less than previously estimated.

Natural Course and Risk Factors for Persistence of IgE-Mediated Cow's Milk Allergy

OBJECTIVE To describe the natural course of IgE-mediated cows milk allergy (IgE-CMA) and to determine risk factors for its persistence in a population-based cohort. STUDY DESIGN In a prospective cohort study, 54 infants with IgE-CMA were identified from a population of 13 019 children followed from birth. Diagnosis of IgE-CMA was based on history, skin prick test (SPT), and an oral food challenge (OFC) when indicated. Allergic infants were followed for 48-60 months. Families were contacted by telephone every 6 months and asked about recent exposures to milk. OFC was repeated to evaluate for recovery. Clinical characteristics, SPT, and OFC outcomes were compared between infants with persistent IgE-CMA and infants who recovered. RESULTS Thirty-one infants (57.4%) recovered from IgE-CMA during the study period. Most infants (70.9%) recovered within the first 2 years. Risk factors for persistence on multivariate analysis included a reaction to <10 mL of milk on OFC (or on first exposure as estimated by the guardian, if OFC was not performed) (P = .01), a larger wheal size on SPT (P = .014), and age of ≤30 days at time of first reaction (P = .05). CONCLUSIONS Resolution occurs in most infants with IgE-CMA. Infants reacting to <10 mL of milk or in the first month of life, and those with a larger wheal size on SPT, are at increased risk for persistence.

Cow's milk associated rectal bleeding: a population based prospective study

Isolated rectal bleeding in infants is often attributed to the consumption of cows milk. However, the prevalence of this condition has not been described, and its preferred diagnostic methods and management are controversial.

Mislabelled cow's milk allergy in infants: a prospective cohort study

Background Although cows milk allergy (CMA) is one of the most common food allergies, mislabelling non-allergic infants as being allergic to cows milk is more common. Despite this, characteristics of families and infants with mislabelled CMA are lacking. Methods Using a prospective population-based study, we identified infants with any possible adverse reaction to cows milk (n=381) from a cohort of 13 019 infants followed from birth. They had a detailed history taken, skin prick tests and an oral food challenge when indicated. Infants with symptoms for which the causative relationship to cows milk protein was excluded were compared with infants with IgE-mediated CMA and with a control group, and followed for 2–5 years. Results Overall, 243 infants (1.87%) with mislabelled CMA were identified. Compared with 66 infants with IgE-mediated CMA, those with mislabelled CMA presented earlier and with symptoms usually involving a single organ system. Doctor-diagnosed atopic dermatitis (AD) was associated with mislabelled CMA (p<0.001), manifested primarily as skin rashes, compared with control infants. Higher maternal and paternal education were also associated with mislabelled CMA (p=0.007 and p=0.035, respectively) and manifested primarily as non-specific symptoms. Conclusions Mislabelled CMA typically presents within the first 3 months of life involving a single organ. Infant AD and higher parental academic education are associated with mislabelled reactions. Better parental and physician awareness of the importance of objectively diagnosing milk allergy is required to avoid mislabelling of infants as being allergic to cows milk and to prevent potential nutritional deficiencies.