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Cow's milk protein allergy Rahaf Hasanein
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Cow's milk protein allergy · 2020. 9. 28. · •Cow's Milk Protein Allergy is an immune system response to one or both of the proteins, Casein & Whey. •Cow's Milk Protein Allergy

Feb 13, 2021

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  • Cow's milk protein allergy Rahaf Hasanein

  • • Cow's Milk Protein Allergy is an immune system response to one or both of the proteins, Casein & Whey.

    • Cow's Milk Protein Allergy (or CMPA) is the most common infant food allergy affecting 1.9% - 4.9% of infants worldwide.

    • Tolerance in 50% of children by the age of 1 year, and in 80-90% by the age of 5 years.

  • Types

    1) The immunoglobulin E (IgE)-mediated type (Immediate reaction) Less than 2 Hours • Urticaria/hives • Wheezing • Rhinitis • Itching or a tingling feeling around the mouth or lips • Angioedema: swelling of the lips, tongue or throat • Coughing or shortness of breath • Vomiting • Anaphylaxis

  • 2) Non-IgE-mediated (Late reaction)

    >= 2 Hours

    • Atopic dermatitis

    • Diarrhea

    • Hematochezia

    • Abdominal cramps

    • Colic

    • Vomiting, GERD

    • Food refusal

  • Food-protein induced enterocolitis syndrome(FPIES) • severe vomiting and diarrhea within 2-4 hours after ingestion of milk

    causing profound dehydration, lethargy, and sometimes shock

    • Chronic exposure my present with regurgitation, diarrhea, failure to thrive, and hypoalbuminemia

  • Food protein-induced proctitis/proctocolitis

    • bloody-streaked, mucousy, loose stools and occasionally diarrhea

  • Food protein-induced enteropathy

    • Protracted diarrhea in the first nine months of life, within weeks after introduction of milk. The majority of affected infants have failure to thrive, and some present with malabsorption.

  • Heiner syndrome (food-induced pulmonary hemosiderosis)

    • Cough, recurrent fever, wheezing, nasal congestion, recurrent otitis media, hemoptysis, failure to thrive, dyspnea, colic, anorexia, vomiting, diarrhea and hematochezia

  • Diagnosis

    1- Histoy and physical exam.

    2- Diagnostic elemination and open challenge test.

    3- other tests.

  • Physical exam

    • Wt and Ht.

    • General exam/appearance.

    • Signs of anemia.

    • Respiratory and gastrointestinal exam.

    • Blood in stool?

    • Skin

  • CMPA Lactose intelorance

  • • If the infant is suspected of having IgE mediated CMPA, then a specific blood IgE level or skin prick test in a clinical setting is often used to aid diagnosis.

    • In severe IgE-mediated CMPA Usually CMP is eliminated from the diet for 12-18 months and then the patient is rechallenged in a clinical setting. If the patient still has reactivity, the elimination diet is continued for another 6-12 months and the patient again is rechallenged.

  • Other tests?

    • Occult blood.

    • CBC.

    • Sigmoidoscopy if bleeding continued for more than 12 weeks after elimination.

  • When re-challenge test is not done?

    • Hx of anaphylactic shock.

  • Thank you