Incidence of cow milk allergy in colicky baby

ABSTRACT

There is a strong relation between infantile colic and the early introduction of cow milk [raw or artificial] to the infants in the first few months of life. Cow milk proteins are responsible for the pathological changes which precipitate the different symptoms of allergy including colic. This study aimed to estimate the prevalence of cow milk allergy [CMA] in the infants suffering from repeated attacks of colic and to determine the adverse effects of CMA. 30 infants suffering from repeated attacks of colic were included in this study. They subjected to full history taking especially the dietary history, also were subjected to clinical examination with special attention to growth development and other signs of allergy. Blood sample was taken to test for CMA including, blood eosinophilic count, total IgE and S-IgE levels to cow milk proteins in the serum. In addition, patients were subjected to an open challenge test to cow milk, which is the gold standard for diagnosis of CMA. 13 children out of the 30 were CMA +ve i-e 43.3% of the studied patients had CMA diagnosed by challenge test. Study of the dietary history revealed that the total and mean duration of exclusive breastfeeding were significantly shorter in CMA+ve than in CMA-ve patients[p < 0.05 for both].in addition the age of first introduction of CM was significantly earlier in CMA+ve compared to CMA-ve patients[p < 0.05]. However, type of milk [raw or artificial or diary product as yogurt], showed no significant difference to the diagnosis of CMA in our study group. Other allergic manifestations were recorded in CMA+ve patients especially infantile eczyma. None of our patients had peripheral eosinophilia. High levels of total IgE and specific IgE were detected in 46.2% and 36.6% respectively. Specific IgE showed a higher specificity than total IgE [100% vs 52.9%].High levels of both total and Specific IgE were significantly more common in CMA+ve patients compared to CMA-ve patients. In addition, IgE - mediated reactions accounted for 46.2% of CMA+ve patients. CMA is a common finding in infants suffering from colic in the first months of life. Early introduction of cow's milk in the first year of life is frequently associated with increase risk of CMA. Testing total and specific IgE for cow milk is a useful tool for the diagnosis of suspicious cases. Challenge test is still the gold standard for the diagnosis of CMA. Although Exclusive breastfeeding in the first 6 months of age is not absolutely protective against all causes of colic, it is still obligatory for the prevention of the development of food allergy