Cow’s milk protein allergy
C. SOLINAS, M. CORPINO, R. MACCIONI, & U. PELOSI Children and Mother Care Department, Paediatrics Unit, S. Barbara Hospital, Iglesias (Received 16 July 2010; revised 16 August 2010; accepted 26 August 2010) Abstract Cow’s milk protein allergy (CMPA) affects 2–7.5% of children;persistence in adulthood is uncommon since a tolerance developing in 51% of cases within the 2 years and 80% within 3–4 years. CMPA is an immunological reaction to one o more milk protein: a-lactalbumin, b-lactoglobulin, casein, IgE or non-IgE associated, responsible of immediate or late onset symptoms. The suspicion of CMPA is based on detailed family and medical history, skin test, patch test,laboratory test, an elimination diet and food challenge. The general treatment for CMPA is dietary: elimination of cow’s milk protein and introduction of extensively hydrolyzed whey or casein formula, aminoacid formula, and soy formula. Extensively hydrolyzed whey or casein formula is recommend as ﬁrst choice for infants in mild or moderate reactions, aminoacid formula in severe CMPA and in caseswith poor response to extensively hydrolysed whey or casein formula. Keywords: Cow’s milk protein allergy, immediate reactions, late onset reaction, skin test, patch test, laboratory test, food challenge, elimination diet, extensively hydrolyzed whey or casein formula, aminoacid formula, soy formula
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Deﬁnition Cow’s milk protein allergy (CMPA) is deﬁned as an immunologically mediated adverse reaction to cow’s milk protein (CMP), and it is the ﬁrst food allergy in childhood and sometimes precedes the development of other food allergies particularly egg and peanuts. Persistence in adulthood is uncommon. It can develop from the neonatal period or during the ﬁrst year of life; ittends to remit in childhood but is often the ﬁrst step of the allergic march. Tolerance developing in 51% of cases within the 2 years after diagnosis and 80% of patients attain the tolerance within 3–4 years . Estimates of the prevalence of CMPA vary from 2 to 7.5% [1–3]. CMPA is an adverse clinical reaction associated with the binding of immunoglobulin (IgE) to antigens capable of elicitingan immune response. Where allergy is not mediated by IgE, other classes of immunoglobulin, immune complexes, or a cell-mediated reaction have been proposed to be involved [1–4]. CMPA results from an immunological reaction to one or more milk proteins, and it may be IgE or non-IgE associated and clinical manifestations can be divided respectively in immediate clinical reactions (IgE mediated) anddelayed reactions (non-IgE or cell-mediated). The immediate reaction are anaphylaxis, cutaneous reaction (acute urticaria, acute angioedema, and contact urticaria) respiratory reaction (wheezing, rhinitis, dry cough, laryngeal edema, and acute asthma with severe respiratory distress) secondary to ingestion or inhalation of CMP; gastrointestinal reaction (diarrhea and vomiting, bloody stools, andoral allergy syndrome). IgE-mediated allergic reactions typically occur within 10–20 min of exposure, the onset of symptoms is rapid, occurring within minutes to an hour after allergen exposure [1–3]. The late onset reaction are cutaneous reaction (atopic dermatitis); respiratory reaction, Heiner’s Syndrome (milk-induced chronic pulmonary disease), gastrointestinal reaction (chronic diarrhea,protein losing entheropathy, enterocolitis, constipation, severe irritability colic, vomiting, gastroesophageal reﬂux disease, eosinophilic esophago-gastro-enteropathy, pyloric stenosis, crico-pharyngeal spasm). Non-IgE-mediated reactions tend to be delayed, with the onset of symptoms occurring from 1 h to several days after ingestion of milk [1–3]. The most important allergens of cow’s milk are...