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KMID : 0816120000030010030
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Korean Journal of Pediatric Gastroenterolology and Nutrition
2000 Volume.3 No. 1 p.30 ~ p.40
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The Three Types of Clinical Manifestation of Cow’s Milk Allergy with Predominantly Intestinal Symptoms
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Lee Jeong-Jin
Kim Yong-Jin
Chung Hai-Lee
Hwang Jin-Bok
Han Chang-Ho
Choi Eun-Jin
Kwon Young-Dae
Kim Hyun-Hee
Lee Eun-Joo
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Abstract
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Purpose : During the first year of life, cow’s milk protein is the major offender
causing food allergy. Cow’s milk allergy (CMA) affects 2∼7% of infants, of which
approximately one-half show predominantly gastrointestinal symptoms. We studied the
clinical types of cow’s milk allergy with predominantly gastrointestinal symptoms
(CMA-GI) of childhood.
Methods : The retrospective study was performed on 30 (male 22, female 8) patients
who had diagnosed as CMA-GI during 2 years and 3 months from March 1995 to June
1997.
Results : 1) Children with CMA-GI presented in the three types of clinical
manifestation on the basis of time to reaction to milk ingestion: Quick (Q) onset (5
cases), Slow (S) onset (20 cases), Quick & Slow (Q&S) (5 cases). 2) Age on admission
of the three groups was significantly different (p<0.05): (Q onset: 81.4±67.1 days, S
onset: 31.9±12.7 days, Q&S: 366.0±65.0 days). Although the body weight at birth was
10∼95 percentile in all patients, body weight on admission was different: (Q onset: 10∼
50 percentile, S onset: below 10 percentile, Q&S: 10∼25 percentile). S onset group was
significantly different compared with other groups (p<0.05) and 90% of this one was
failure to thrive below 3 percentile. 3) Peripheral leukocyte counts were as followings:
(Q onset: 5,700∼12,300/㎣, S onset: 10,000∼33,400/㎣, Q&S 5,200∼14,900/㎣). Slow
onset group was significantly different compared with other groups (p<0.05). Serum
albumin levels on admission were as followings: (Q onset: 4.2±0.4g/dl, S onset: 3.0±
0.3g/dl, Q&S: 4.0±0.3g/dl). S onset froup was significantly different compared with other
groups(p<0.05) and 85% of this one was below 3.5g/dl. 4) Although morphometrical
analysis on small intestinal mucosa did not show enteropathy in Q onset and Q&S
groups, all cases of S onset revealed enteropathy: 45% of this one showed subtotal
villous atrophy, 55% showed partial villous atrophy. 5) Allergic reaction test to other
foods was not performed in S onset group because of ethical problem and high risk in
general condition. In Q onset group, allergic reaction to one or two other foods: soy
formula, weaning formula and eggs. Q&S group revealed allergic reactions to several
foods or to most of all foods except protein hydrolysate formula: eggs, potatos, some
kinds of sea food, apples, carrots, beef and chicken. 6) Serum IgE level, peripheral
eosinophil counts, milk RAST, soy RAST, skin test were not significantly different
among groups.
Conclusion : CMA-GI may present in three clinical ways on the basis of time to
reaction to milk ingestion, typical clinical findings and morphologic changes in the small
bowel mucosal biopsy specimens. This clinical subdivision might be helpful in diagnostic
and therapeutic approaches in CMA-GI. Early suspicion is mandatory especially in S
onset type because of high risks with malnutrition and enteropathy.
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KEYWORD
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Cow’s milk allergy, Intestinal, Clinical manifestation,
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