[Evaluation of Cow's milk allergy among infants with bloody stools]

ABSTRACT

Cow's milk allergy [CMA] is an immunologic phenomenon to the proteins present in Cow's milk. It frequently appears with gastrointestinal [GI] problems such as abdominal pain, diarrhea and bloody stool. Its frequency is about 1.9 - 7.5% and symptoms usually appear in early months of life. In this study, we assess CMA in infants with rectorrhagia. In this study infants [< 2years] with complaints of rectorrhagia reporting at the children's clinic at Imam Khomeini Hospital were included. Inclusion criteria comprised of parents' report of passage of bloody stools, absence of infeetion and local conditions such as anal fissure, acidic PH and lactase deficiency. Then formal consents were taken, skin prick test and open food challenge test were performed. Those who were refractory to diet without cow's milk protein were assessed by colonoscopic procedure. Among 198 infants with rectorrhagia, 51 patients were eligible for this study [41% bo1.s . 58.8% girl and with mean age of 5.3 month] . Besides rectorrhagia other manifestation was diarrhea [80%], abdominal pain [56.9%]. Atopic dermatitis [21.6%] and recurrent vomiting [10%]. Skin prick test were done in 37 cases which was positive in 18 pts. 47 patients had positive challenge tests, in 4 patients with negative challenge test was colonsopy performed. Two cases had nodularity with eosinophilia infiltration, allergic colitis were reported in the others. All patients [including these 4 cases] reponded well to exclusion diet. It has been shown in this study that Cow's Milk Allergy [CMA] has a significant prevalence in infants [<2 years] with rectorrhagia . The definite diagnosis is made by challenge test and the treatment is exclusion diet. According to the results, it is recommended that CMA should be taken in to consideration in children exhibiting gastrointestinal symptoms