Title: P0500 MANAGEMENT OF COW???S MILK PROTEIN ALLERGY IN INFANTS; IS AN ORAL MILK CHALLENGE NECESSARY?
Abstract: Introduction: Cow’s milk protein allergy (CMPA) is common and occurs in about 5–7% of infants. The gut is involved most commonly leading to an enteropathy and/or colitis. Withdrawal of cow’s milk protein from the diet leads to prompt improvement. This involves switching to a semi-elemental or an elemental formula. In breast-fed babies, milk protein has to be excluded from the mother’s diet. Most infants will outgrow CMPA within the first two years of life and milk is allowed and tolerated in the diet at that time. There is controversy whether they need an oral milk challenge in a controlled environment before milk is allowed in the diet. The objective of the study was to examine the current practices and recommendations of pediatric gastroenterologists regarding the management of CMPA and to investigate the outcome of oral milk challenge if infants with CMPA. Methods: All pediatric gastroenterologists in Canada were surveyed with a questionnaire. Clinical records of all infants with CMPA who underwent an oral milk challenge in our Gastroenterology Day Care clinic over a six-year period were reviewed. Results: All 38 (100%) pediatric gastroenterologists responded to the questionnaire. In non-breast fed babies with CMPA, 13% recommended a soy formula, 68% semi-elemental formula and 18% elemental formula. 68% did not recommend a controlled oral milk challenge before allowing milk in the diet. 8% recommended challenge /or allowed milk at 9 months of age, 47% at 12 months of age, 24% at 18 months, and 21% were undecided. Of the 48 patients with CMPA, 58% were male. Mean age at diagnosis was 2.6 months, range 0–12. All had gastrointestinal symptoms of CMPA and none had anaphylaxis. Mean age of oral milk challenge was 15 months. 35% failed the challenge. Most reactions were immediate and included vomiting, irritability, diarrhoea and rash. One developed anaphylactic shock. No deaths occurred. Of those who failed the first challenge, 44% were re-challenged after a year. In final analysis, 21% did not pass the two challenges. A third challenge was not done. Neither the symptoms at presentation nor the laboratory abnormalities were predictive of the challenge outcome. Conclusion: There are significant variations in the recommendations regarding management of CMPA in infants. Serious reactions can occur with milk reintroduction. Clinical feature may not permit selection of infants for challenge. Before milk is allowed at home, all infants with CMPA should have an oral milk challenge under controlled conditions in a health care facility.
Publication Year: 2004
Publication Date: 2004-06-01
Language: en
Type: article
Indexed In: ['crossref']
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