Upper and Lower Gastrointestinal Tract Bleeding Induced by Whole Cow's Milk in an Atopic Infant

Abstract

The case of a 5-month-old infant who developed hematemesis as well as lower intestinal tract bleeding following a second exposure to homogenized cow's milk is presented as an example of unusually severe cow's milk allergy. Serum precipitins, hemagglutinins, and PCA antibodies were all present at the time of the acute reaction, but only skin-sensitizing antibodies could be demonstrated when the infant was asymptomatic and not ingesting milk. Hypocalcemia, an elevated serum alkaline phosphatase level, and a marked microcytic, hypochromic anemia were associated with milder manifestations of milk intolerance in this same patient 2 months earlier. This unusual triad of laboratory findings can be interpreted as resulting from early damage to the intestinal mucosa by a local milk-antigen-antibody interaction.