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Persistent cow's milk protein intolerance in infants: the changing faces of the same disease
G Iacono1, F Cavataio, G Montalto
1II Divisione di Pediatria, Ospedale Di Cristina, Università di Palermo, Italy.
Insights
Cow's milk protein intolerance (CMPI) can persist beyond age four, often linked to family history of atopy. Persistent CMPI is associated with evolving symptoms, delayed reactions, and multiple food intolerances.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Clinical Nutrition
Background:
- Cow's milk protein intolerance (CMPI) frequently persists beyond early childhood.
- Understanding the long-term characteristics of persistent CMPI is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the clinical and immunological features of infants with persistent cow's milk protein intolerance (CMPI).
- To identify factors associated with prolonged CMPI beyond four years of age.
Main Methods:
- Longitudinal follow-up of 12 infants with persistent CMPI until a median age of 5 years.
- Annual cow's milk protein (CMP) challenges to assess tolerance.
- Comparison with 26 infants whose CMPI resolved within 1-2 years.
Main Results:
- Persistent CMPI cases showed a higher prevalence of family history of atopic disease (10/12 vs 10/26).
- Clinical manifestations evolved from gastrointestinal issues to increased wheezing, constipation, and delayed reactions (9/12).
- Multiple food intolerances (11/12) and allergic diseases like asthma and eczema (9/12) were significantly more common in persistent CMPI.
Conclusions:
- Persistent CMPI is strongly associated with familial atopy.
- Manifestations of persistent CMPI change over time, with delayed symptom onset after CMP exposure.
- High comorbidity with multiple food intolerances and allergic diseases characterizes persistent CMPI.
Background:
Recent research has shown that cow's milk protein intolerance (CMPI) often persists beyond 4 years of age.
Aims:
To evaluate the clinical and immunological characteristics of a group of infants with persistent CMPI.
Patients And Methods:
Twelve infants (6 m, 6f) with persistent CMPI were followed up from birth until a median age of 5 years. The patients underwent CMP challenge each year to evaluate CMP-tolerance. As controls we followed 26 infants (12 m, 14 f) with CMPI that resolved within 1-2 years.
Results:
A family history of atopic disease was found in 10/12 patients with persistent CMPI and in 10/26 controls (P<0.01). Clinical presentation changed over time: at onset symptoms were prevalently gastrointestinal, while at the end of the study there was an increased frequency of wheezing and constipation and a higher frequency of delayed reactions to CMP-challenge than at study commencement (9/12 vs 2/12; P<0.007). 11/12 infants with persistent CMPI and 3/26 controls (P<0.0001) presented multiple food intolerance. During the observation period 9/12 infants with persistent CMPI and 2/26 controls showed atopic disease: asthma, rhinitis, eczema (P < 0.0001).
Conclusions:
Persistent CMPI forms are characterized by: (a) considerable importance of familial atopic disease; (b) change in CMPI manifestations over time and more prolonged delay between CMP consumption and manifestation of symptoms; (c) very high frequency of multiple food intolerance and allergic diseases.