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Atypical presentation of a common condition

Mariana Oliveira Pereira1, Rita Lages Pereira1, Fábia Carvalho1

  • 1Department of Paediatrics, Hospital de Braga, Braga, Portugal.

Journal of Neonatal-Perinatal Medicine
|February 20, 2025
PubMed

Insights

Cow's milk protein allergy (CMPA) can manifest unusually, even without gut issues. Early diagnosis using clinical history and tests like IgE measurements is key for infants with atypical CMPA symptoms.

Area of Science:

  • Pediatrics
  • Allergy Immunology

Background:

  • Cow's milk protein allergy (CMPA) exhibits diverse clinical presentations.
  • Gastrointestinal symptoms are common but not universally present in CMPA.
  • Atypical presentations can pose diagnostic challenges in infants.

Purpose of the Study:

  • To highlight the variability of CMPA manifestations.
  • To emphasize the importance of considering CMPA in infants with non-gastrointestinal symptoms.
  • To underscore the diagnostic approach for atypical CMPA cases.

Main Methods:

  • Case report of two infants with atypical CMPA.
  • Introduction of extensively hydrolyzed formula (eHF) for symptom management.
  • Diagnostic confirmation through specific IgE measurements and oral provocation testing.

Main Results:

  • Both infants presented with non-gastrointestinal symptoms (polyarthritis, rash, extremity swelling).
  • Symptoms resolved upon switching to eHF, supporting CMPA diagnosis.
  • Specific IgE and oral provocation test confirmed CMPA in one case.

Conclusions:

  • CMPA can present with a wide spectrum of symptoms beyond the gastrointestinal tract.
  • Clinical diagnosis, supported by objective tests, is crucial for managing CMPA.
  • Recognizing diverse CMPA presentations aids in timely and accurate diagnosis.

Keywords:
IgE-mediated allergycow’s milk protein allergyfood allergynewborn

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