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Importance of evaluating for cow's milk allergy in pediatric surgical patients with functional bowel symptoms
Kayo Ikeda1, Shinobu Ida, Hisayoshi Kawahara
1Department of Pediatric Gastroenterology and Nutrition, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Insights
Cow's milk allergy (CMA) can complicate the care of pediatric surgical patients with bowel issues. Early suspicion and diagnosis of CMA are crucial for effective management and symptom resolution in this population.
Area of Science:
- Pediatric Surgery
- Allergy and Immunology
- Gastroenterology
Background:
- Cow's milk allergy (CMA) frequently causes functional bowel symptoms.
- These symptoms can complicate the management of pediatric surgical patients.
- The interplay between CMA and surgical conditions requires careful evaluation.
Purpose of the Study:
- To investigate the impact of Cow's milk allergy (CMA) on the management of pediatric surgical patients.
- To analyze the diagnostic challenges and therapeutic approaches for pediatric surgical patients with concurrent CMA.
- To highlight the importance of considering CMA in the differential diagnosis of bowel symptoms in this cohort.
Main Methods:
- Retrospective review of 14 pediatric surgical patients diagnosed with CMA.
- Diagnosis of CMA based on clinical presentation and lymphocyte stimulation test (LST).
- Analysis of patient management strategies and outcomes based on symptom presentation and diagnosis timing.
Main Results:
- Common symptoms included abdominal distension, vomiting, constipation, and apnea.
- Elevated LST median values (731%) confirmed CMA in patients.
- Effective symptom management was achieved through Cow's milk elimination therapy, particularly when CMA was diagnosed promptly.
Conclusions:
- A high index of suspicion for concurrent Cow's milk allergy is essential for pediatric surgical patients presenting with bowel symptoms.
- Prompt diagnosis and elimination of cow's milk can significantly improve outcomes.
- This underscores the need for integrated care between surgical and allergy/immunology teams.
Background:
Cow's milk allergy (CMA) can cause functional bowel symptoms. This can lead to confusion and difficulty in managing pediatric surgical patients who also have CMA. We examined CMA's effect on the management of pediatric surgical patients in our institute.
Methods:
With institutional review board approval, 14 pediatric surgical patients with CMA were reviewed. Cow's milk allergy was diagnosed according to clinical findings and stimulation index (normal range <300%) of the lymphocyte stimulation test.
Results:
The main symptoms were abdominal distension (n = 10), vomiting (n = 6), constipation (n = 2), and apnea (n = 1). Stimulation index median value was 731% (range, 341%-2132%). Patients were divided into 3 groups. In group 1 (n = 8), persistent postoperative bowel symptoms were initially considered related to surgical diseases. Following CMA diagnosis, CM elimination therapy improved symptoms. In group 2 (n = 4), CMA was diagnosed concurrently with surgical disease, and elimination therapy was continued postoperatively. In group 3 (n = 2), the pathogenesis of bowel symptoms was initially attributed to CMA and later diagnosed as Hirschsprung's disease.
Conclusions:
A high index of suspicion regarding the possibility of concurrent CMA may be necessary to manage bowel symptoms in pediatric surgical patients.
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