Abstract
Cow’s milk is the most common cause of food-protein-induced enterocolitis syndrome (FPIES). The aim of this study was to examine the clinical features and treatment outcomes of infants with severe FPIES to cow’s milk. We reviewed all infants ≤12 months of age who were hospitalized and diagnosed with severe FPIES to cow’s milk between 1 January 2011 and 31 August 2014 in a tertiary Children’s Medical Center in China. Patients’ clinical features, feeding patterns, laboratory tests, and treatment outcomes were reviewed. A total of 12 infants met the inclusion criteria. All infants presented with diarrhea, edema, and hypoalbuminemia. Other main clinical manifestations included regurgitation/vomiting, skin rashes, low-grade fever, bloody and/or mucous stools, abdominal distention, and failure to thrive. They had clinical remission with resolution of diarrhea and significant increase of serum albumin after elimination of cow’s milk protein (CMP) from the diet. The majority of infants developed tolerance to the CMP challenge test after 12 months of avoidance. In conclusion, we reported the clinical experience of 12 infants with severe FPIES to cow’s milk, which resulted in malnutrition, hypoproteinemia, and failure to thrive. Prompt treatment with CMP-free formula is effective and leads to clinical remission of FPIES in infants.
Highlights
Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and young children and can induce a diverse range of symptoms of variable intensity in infants, involving many different organ systems, mostly the gastrointestinal tract [1,2]. It is the most common cause of food-protein-induced enterocolitis syndrome (FPIES) in infants, who usually present with recurrent vomiting, lethargy, pallor, diarrhea with blood and/or mucus, and dehydration with metabolic acidosis in the acute setting, and hypoalbuminemia and failure to thrive in a chronic form [3,4,5,6,7]
The diagnosis of severe FPIES to cow’s milk was based on the criteria described by others: (a) repeated exposure to cow’s milk elicited repetitive vomiting and/or diarrhea within 24 h, without any other cause for the symptoms; (b) removal of cow’s milk protein (CMP) from the diet resulted in resolution of symptoms and a food challenge elicited vomiting and/or diarrhea within two weeks after administration of the food containing CMP to observe for any immediate and delayed clinical reactions [1,5,6,8,9]; (c) Infants had severe shock-like reactions with dehydration and metabolic acidosis in the acute setting and/or hypoalbuminemia and failure to thrive in a chronic form [1,7]
Laboratory tests showed that all infants (100%) had hypoproteinemia (25.3 to 45.5 g/L, normal reference 60 to 80 g/L), hypoalbuminemia (14.5 to 24.8 g/L, normal reference 35 to 50 g/L); 9 (75%) infants had decreased serum globulin (10.8 to 19.5 g/L, normal reference 20 to 29 g/L)
Summary
Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and young children and can induce a diverse range of symptoms of variable intensity in infants, involving many different organ systems, mostly the gastrointestinal tract [1,2]. It is the most common cause of food-protein-induced enterocolitis syndrome (FPIES) in infants, who usually present with recurrent vomiting, lethargy, pallor, diarrhea with blood and/or mucus, and dehydration with metabolic acidosis in the acute setting, and hypoalbuminemia and failure to thrive in a chronic form [3,4,5,6,7]. We reported the first clinical experience of Chinese infants with severe FPIES to cow’s milk
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
