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Published on: December 16, 2015
Cow's milk protein-sensitive enteropathy at school age.
J Kokkonen1, M Haapalahti, K Laurila
1Department of Pediatrics, Oulu University Hospital, Finland.
The Journal of Pediatrics
|December 18, 2001
Summary
Cow's milk protein-sensitive enteropathy (CMSE) is an identifiable condition in school-aged children. Diagnosis relies on clinical assessment, elimination-challenge tests, and characteristic endoscopic and histologic findings.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Allergy
Background:
- Cow's milk protein-sensitive enteropathy (CMSE) can persist into school age.
- Defining the features of persistent CMSE is crucial for diagnosis and management.
Purpose of the Study:
- To define the morphologic and immunohistochemical features of persistent CMSE in school-aged children.
- To differentiate CMSE from celiac disease and healthy controls.
Main Methods:
- Studied 15 children with definite CMSE, 12 with suspected CMSE, 11 with celiac disease, and 12 controls.
- Utilized blind challenge, endoscopic evaluation, duodenal biopsy, and immunohistochemistry.
Main Results:
- CMSE showed lymphonodular hyperplasia and lymphoid follicles without villous atrophy.
- Increased intraepithelial T cells (gammadelta(+) skewed) were observed in CMSE patients.
- No aberrant HLA-DR expression or increased HLA DQ2 prevalence was found in CMSE.
Conclusions:
- CMSE is an identifiable clinical entity in school-aged children.
- Immunohistochemical findings suggest local loss of antigen tolerance in the GI mucosa.
- Diagnosis requires clinical assessment, elimination-challenge tests, and characteristic endoscopic/histologic findings.
