Abstract Objective To investigate the epidemiological and clinical features of cow's milk protein allergy (CMPA) in infants presenting mainly with gastrointestinal symptoms. Methods A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms. Results Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants (61.1%), hematochezia in 149 infants (53.2%), vomiting in 71 infants (25.4%), eczema in 57 infants (20.4%), malnutrition in 42 infants (15%) and constipation in 13 infants (4.6%). Of the 280 infants, 258 (92.1%) had mild-to-moderate CMPA and 22 (7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition (50.0% vs 12.0%) and a signifcantly lower incidence rate of hematochezia (22.7% vs 55.8%). The breastfeeding CMPA group had signifcantly lower incidence rates of malnutrition (10.3% vs 24.6%) and severe CMPA (4.4% vs 18.0%) than the artifcial feeding CMPA group, and the artifcial feeding CMPA group had a signifcantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups (37.7% vs 56.6%/59.0%). Conclusions CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artifcial feeding is more likely to cause malnutrition and severe CMPA.
YANG Qing-Hua,ZHENG Bing-Sheng,ZHOU Shao-Ming et al. Clinical features of cow's milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases[J]. CJCP, 2019, 21(3): 271-276.
YANG Qing-Hua,ZHENG Bing-Sheng,ZHOU Shao-Ming et al. Clinical features of cow's milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases[J]. CJCP, 2019, 21(3): 271-276.
Lin RY, Anderson AS, Shah SN, et al. Increasing anaphylaxis hospitalizations in the frst 2 decades of life:New York State, 1990-2006[J]. Ann Allergy Asthma Immunol, 2008, 101(4):387-393.
[7]
Tejedor-Alonso MA, Moro-Moro M, Mosquera Gonzalez M, et al. Increased incidence of admissions for anaphylaxis in Spain 1998-2011[J]. Allergy, 2015, 70(7):880-883.
[8]
Nwaru BI, Hickstein L, Panesar SS, et al. Prevalence of common food allergies in Europe:a systematic review and meta-analysis[J]. Allergy, 2014, 69(8):992-1007.
[9]
Fiocchi A, Brozek J, Schünemann H, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines[J]. Pediatr Allergy Immunol, 2010, 21(Suppl 21):1-125.
[10]
Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy:a meta-analysis[J]. J Allergy Clin Immunol, 2007, 120(3):638-646.
[11]
Martorell A, Plaza AM, Boné J, et al. Cow's milk protein allergy. A multi-centre study:clinical and epidemiological aspects[J]. Allergol Immunopathol (Madr), 2006, 34(2):46-53.
[12]
Høst A, Halken S. A prospective study of cow milk allergy in Danish infants during the frst 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction[J]. Allergy, 1990, 45(8):587-596.
[13]
Morita H, Suzuki H, Orihara K, et al. Food protein-induced enterocolitis syndromes with and without bloody stool have distinct clinicopathologic features[J]. J Allergy Clin Immunol, 2017, 140(6):1718-1721. e6.
[14]
Koletzko S, Niggemann B, Arato A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children:ESPGHAN GI Committee practical guidelines[J]. J Pediatr Gastroenterol Nutr, 2012, 55(2):221-229.
[15]
Fleischer DM, Perry TT, Atkins D, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study[J]. Pediatrics, 2012, 130(1):e25-e32.
[16]
Shah E, Pongracic J. Food-induced anaphylaxis:who, what, why, and where?[J]. Pediatr Ann, 2008, 37(8):536-541.
[17]
Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States[J]. Pediatrics, 2011, 128(1):e9-e17.
[18]
Luyt D, Ball H, Makwana N, et al. BSACI guideline for the diagnosis and management of cow's milk allergy[J]. Clin Exp Allergy, 2014, 44(5):642-672.
[19]
Lam HY, van Hoffen E, Michelsen A, et al. Cow's milk allergy in adults is rare but severe:both casein and whey proteins are involved[J]. Clin Exp Allergy, 2008, 38(6):995-1002.
[20]
Matheson MC, Allen KJ, Tang ML. Understanding the evidence for and against the role of breastfeeding in allergy prevention[J]. Clin Exp Allergy, 2012, 42(6):827-851.
[21]
Munblit D, Peroni DG, Boix-Amorós A, et al. Human milk and allergic diseases:an unsolved puzzle[J]. Nutrients, 2017, 9(8). pii:E894.
[22]
Jarrett EE. Perinatal influences on IgE responses[J]. Lancet, 1984, 2(8406):797-799.
[23]
Ierodiakonou D, Garcia-Larsen V, Logan A, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease:a systematic review and metaanalysis[J]. JAMA, 2016, 316(11):1181-1192.
[24]
Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy[J]. N Engl J Med, 2015, 372(9):803-813.
[25]
Saarinen KM, Juntunen-Backman K, Järvenpää AL, et al. Breast-feeding and the development of cows' milk protein allergy[J]. Adv Exp Med Biol, 2000, 478:121-130.
Iacono G, Cavataio F, Montalto G, et al. Persistent cow's milk protein intolerance in infants:the changing faces of the same disease[J]. Clin Exp Allergy, 1998, 28(7):817-823.
[28]
Salminen S, Gibson GR, McCartney AL, et al. Influence of mode of delivery on gut microbiota composition in seven year old children[J]. Gut, 2004, 53(9):1388-1389.
[29]
Tsabouri S, Priftis KN, Chaliasos N, et al. Modulation of gut microbiota downregulates the development of food allergy in infancy[J]. Allergol Immunopathol (Madr), 2014, 42(1):69-77.
ZHANG Ji-Yong, ZHOU Shao-Ming, WANG Shao-Hua, SUI Feng-Xuan, GAO Wu-Hong, LIU Qing, CAI Hua-Bo, JIANG Hong-Ying, LI Wei-Yan, WANG Li-Ting, LI Li, ZHAO Wei, YING Jing, WU Qian-Zhen, WENG Bi-Xia, ZENG Yong-Mei. Risk factors for cow's milk protein allergy in infants: a multicenter survey[J]. CJCP, 2020, 22(1): 42-46.