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Original ArticleOpen Access
Gastrointestinal Manifestations of Cow's Milk Protein Allergy During the First Year of Life
Yimyaem P 
,
Chongsrisawat V ,
Vivatvakin B ,
Wisedopas N
,
Chongsrisawat V ,
Vivatvakin B ,
Wisedopas N VORANUSH CHONGSRISAWAT, MD*,
NARUEMON WISEDOPAS, MD**
Background
: Cow's milk protein sensitive enteropathy (CMPSE) is a common condition
in the first year of life. Clinically CMPSE usually presents with symptoms like vomiting, chronic
diarrhea, mucous bloody diarrhea and hematemesis. More unusual symptoms associated with CMPSE
are infantile colic, gastroesophageal reflux and chronic constipation. The objective of this study was
to assess the gastrointestinal manifestations and allergic march in CMPSE patients.
Method
:The authors reviewed the records of 10 CMPSE patients observed by the Gastro-
intestinal Unit at King Chulalongkorn Memorial Hospital from 1997-200 I including patient charac-
teristics, laboratory investigations, endoscopy and follow-up outcome.
Results
: Of 10 CMPSE patients, the median age of CMPSE onset was 3.5 months. The
gastrointestinal manifestations were hematemesis (n
= 6),
mucous bloody diarrhea (n
= 3)
and chronic
watery diarrhea (n
=
2). Exclusively breast-fed infants seemed to have more delayed onset of symp-
toms than those who were not. Anemia (n
=
3), high serum IgE (n
=
4) and positive skin prick test for
cow's milk (n
=
5) were found. Neither peripheral eosinophilia nor hypoalbuminemia was found.
Endoscopy revealed acute and chronic gastritis. Treatment was successful by changing to soy or exten-
sive hydrolysate formula with mean duration of cow's milk intolerance of 24 months. In 2-year
follow-up, three of ten patients who had high serum lgE level developed allergic rhinitis and eczema.
Conclusion
: CMPSE can be manifested in various symptoms. Exclusive breast feeding for
more than 4 months can postpone the onset of CMPSE. Serum lgE or specific lgE level to cow's milk
protein may identify the atopic career of CMPSE individuals.
Key word
: Cow's Milk Protein Allergy, Infant, Gastrointestinal Manifestation
NARUEMON WISEDOPAS, MD**
Background
: Cow's milk protein sensitive enteropathy (CMPSE) is a common condition
in the first year of life. Clinically CMPSE usually presents with symptoms like vomiting, chronic
diarrhea, mucous bloody diarrhea and hematemesis. More unusual symptoms associated with CMPSE
are infantile colic, gastroesophageal reflux and chronic constipation. The objective of this study was
to assess the gastrointestinal manifestations and allergic march in CMPSE patients.
Method
:The authors reviewed the records of 10 CMPSE patients observed by the Gastro-
intestinal Unit at King Chulalongkorn Memorial Hospital from 1997-200 I including patient charac-
teristics, laboratory investigations, endoscopy and follow-up outcome.
Results
: Of 10 CMPSE patients, the median age of CMPSE onset was 3.5 months. The
gastrointestinal manifestations were hematemesis (n
= 6),
mucous bloody diarrhea (n
= 3)
and chronic
watery diarrhea (n
=
2). Exclusively breast-fed infants seemed to have more delayed onset of symp-
toms than those who were not. Anemia (n
=
3), high serum IgE (n
=
4) and positive skin prick test for
cow's milk (n
=
5) were found. Neither peripheral eosinophilia nor hypoalbuminemia was found.
Endoscopy revealed acute and chronic gastritis. Treatment was successful by changing to soy or exten-
sive hydrolysate formula with mean duration of cow's milk intolerance of 24 months. In 2-year
follow-up, three of ten patients who had high serum lgE level developed allergic rhinitis and eczema.
Conclusion
: CMPSE can be manifested in various symptoms. Exclusive breast feeding for
more than 4 months can postpone the onset of CMPSE. Serum lgE or specific lgE level to cow's milk
protein may identify the atopic career of CMPSE individuals.
Key word
: Cow's Milk Protein Allergy, Infant, Gastrointestinal Manifestation
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