Cows milk protein allergy Rahaf Hasanein Cows Milk

Cow's milk protein allergy Rahaf Hasanein

• Cow's Milk Protein Allergy is an immune system response to one or both of the proteins, Casein & Whey. • Cow's Milk Protein Allergy (or CMPA) is the most common infant food allergy affecting 1. 9% - 4. 9% of infants worldwide. • Tolerance in 50% of children by the age of 1 year, and in 80 -90% by the age of 5 years.

Types 1) The immunoglobulin E (Ig. E)-mediated type (Immediate reaction) Less than 2 Hours • Urticaria/hives • Wheezing • Rhinitis • Itching or a tingling feeling around the mouth or lips • Angioedema: swelling of the lips, tongue or throat • Coughing or shortness of breath • Vomiting • Anaphylaxis

2) Non-Ig. E-mediated (Late reaction) >= 2 Hours • Atopic dermatitis • Diarrhea • Hematochezia • Abdominal cramps • Colic • Vomiting, GERD • Food refusal

Food-protein induced enterocolitis syndrome(FPIES) • severe vomiting and diarrhea within 2 -4 hours after ingestion of milk causing profound dehydration, lethargy, and sometimes shock • Chronic exposure my present with regurgitation, diarrhea, failure to thrive, and hypoalbuminemia

Food protein-induced proctitis/proctocolitis • bloody-streaked, mucousy, loose stools and occasionally diarrhea

Food protein-induced enteropathy • Protracted diarrhea in the first nine months of life, within weeks after introduction of milk. The majority of affected infants have failure to thrive, and some present with malabsorption.

Heiner syndrome (food-induced pulmonary hemosiderosis) • Cough, recurrent fever, wheezing, nasal congestion, recurrent otitis media, hemoptysis, failure to thrive, dyspnea, colic, anorexia, vomiting, diarrhea and hematochezia

Diagnosis 1 - Histoy and physical exam. 2 - Diagnostic elemination and open challenge test. 3 - other tests.

Physical exam • Wt and Ht. • General exam/appearance. • Signs of anemia. • Respiratory and gastrointestinal exam. • Blood in stool? • Skin

CMPA Lactose intelorance

• If the infant is suspected of having Ig. E mediated CMPA, then a specific blood Ig. E level or skin prick test in a clinical setting is often used to aid diagnosis. • In severe Ig. E-mediated CMPA Usually CMP is eliminated from the diet for 12 -18 months and then the patient is rechallenged in a clinical setting. If the patient still has reactivity, the elimination diet is continued for another 6 -12 months and the patient again is rechallenged.

Other tests? • Occult blood. • CBC. • Sigmoidoscopy if bleeding continued for more than 12 weeks after elimination.

When re-challenge test is not done? • Hx of anaphylactic shock.

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