Cow&s milk protein allergy with gastrointestinal manifestations
Keywords:Children, cow’s milk protein allergy, gastroin- testinal manifestations, management
Cow’s milk protein allergy (CMPA) is the leading cause of food allergy in children under three years of age, although its gastrointestinal manifestations may occur in all age groups. In the suspicion of CMPA based on the anamnesis and physical examination, an elimination diet should be initiated for a variable length of time according to the clinical picture, followed by an oral food challenge (OFC) confi rming or excluding the diagnosis. Complementary exams such as skin prick tests and specifi c IgE may be necessary. Treatment is based on an elimination diet and demands nutritional counselling and growth monitoring. Usually an OFC is repeated after three to 12 months of elimination diet. Tolerance is achieved at three years of age in more than 80% of the children. The aim of this work is to make a brief review and update on CMPA in pediatric age, proposing a management approach based on recent international recommendations.
Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1-58.
Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805-19.
Rona RJ, Keil T, Summers C, David Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 2007; 120:638-46.
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. WAO J 2010; 3:57-161.
Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow´s milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012; 55:221-9.
Roehr CC, Edenharter G, Reimann S, Ehlers I, Worm M, Zuberbier T, et al. Food allergy and non-allergic food hypersensitivity in children and adolescents. Clin Exp Allergy 2004; 34:1534-41.
Høst A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002; 89:33-7.
Kvenshagen B, Halvorsen R, Jacobsen M. Adverse reactions to milk in infants. Acta Paediatr 2008; 97:196-200.
National Institute for Health and Clinical Excellence. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. London; 2011. Disponível em: http://www.nice.org.uk/CG116
Caubet JC, Nowak-Wegrzyn A. Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol 2011; 7:317-27.
Troncone R, Discepolo V. Colon in Food Allergy. J Pediatr Gastroenterol Nutr 2009; 48:S89-91.
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128:3-20.
Farahmand F, Najafi M, Ataee P, Modarresi V, Shahraki T, Rezaei N. Cow’s Milk Allergy among Children with Gastroesophageal Refl ux Disease. Gut Liver 2011; 5:298-301.
Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics 2002; 110:972-84.
Carroccio A, Iacono G. Review article: chronic constipation and food hypersensitivity – an intriguing relationship. Aliment Pharmacol Ther 2006; 24:1295-304.
Lucassen PL, Assendelft WJ. Systematic review of treatments for infant colic. Pediatrics 2001; 108:1047-8.
Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P; et al. Cow´s milk protein allergy in children: a practical guide. Ital J Pediatr 2010; 36:5.
Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, et al. Guidelines for the diagnosis and management of cow´s milk protein allergy in infants. Arch Dis Child 2007; 92:902-8.
Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS; Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: Oral food challenge testing. J Allergy Clin Immunol 2009; 123:S365-83.
Yum HY, Yang HJ, Kim KW, Song TW, Kim WK, Kim JH, et al. Oral food challenges in children. Korean J Pediatr 2011; 54:6-10.
Canani RB, Costanzo MD, Troncone R. The optimal diagnostic workup for children with suspected food allergy. Nutrition 2011; 27:983-7.
Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy 2010; 40:1442-60.
Dupont C, Chouraqui JP, de Boissieu D, Bocquet A, Bresson JL, Briend A, et al. Dietary treatment of cows’ milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics. Br J Nutr 2012; 107:325-38.
Reche M, Pascual C, Fiandor A, Polanco I, Rivero-Urgell M, Chifre R, et al.The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow’s milk protein allergy. Pediatr Allergy Immunol 2010; 21:577-85.
Savino F, Castagno E, Monti G, Serraino P, Peltran A, Oggero R, et al. Z-score of weight for age of infants with atopic dermatitis and cow’s milk allergy fed with a rice-hydrolysate formula during the fi rst two years of life. Acta Paediatr Suppl 2005; 94:115-9.
Caldeira F, Cunha J, Ferreira MG. Alergia a proteínas de leite de vaca: um desafi o diagnóstico. Acta Med Port 2011; 24: 505-10.
Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. The Cochrane Database Syst Rev 2012; 9:CD000133.
Vanderhoof JA. Probiotics in allergy managment. J Pediatric Gastroenterol Nutr 2008; 47:S38-40.
Osborn DA, Sinn JK. Prebiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007; 17:CD006474.
Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; 18:CD003664.
Lowe AJ, Dharmage SC, Allen KJ, Tang ML, Hill DJ. The role of partially hydrolysed formula for the prevention of allergic disease: evidence and gaps. Expert Rev Clin Immunol 2013; 9:31-41.
Høst A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow’s milk protein allergy/ intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 2002;13:23-8.
How to Cite
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.