engleski

biopsies in children with intestinal forms of cow` s milk allergy

Introduction: Cow’ s milk allergy (CMA) occurs in 5-15% of infants and it is estimated that 30-50% of them present with gastrointestinal symptoms. Correlation of clinical symptoms and laboratory findings is considered poor ; hence the challenge test remains the gold standard for diagnosis. The aim of this study was to determine the usefulness of rectal biopsies in evaluating infants with suspected gastrointestinal form of milk allergy. Material and methods: We treated 48 children (mean age 5 months) with reaction to cow’ s milk that presented with symptoms involving the gastrointestinal system (vomiting, diarrhoea, hematochesia or failure to thrive). Planed work-up was to determine the blood eosinophil count (eo), total IgE, perform skin prick test and examine rectal biopsies. The diagnosis was based on suggestive clinical manifestations and at least some positive tests mentioned above, as well as symptom withdrawal on a milk-free diet. Unfortunately, most parents refused the proposed challenge test to confirm the diagnosis lege artis. Results: Diarrhea was the presenting gastrointestinal symptom in most children (79%). Some had reactions involving other systems, respiratory or the skin (56%). Increased peripheral blood eosinophil count (>0, 44x1012/L) was found in 40% of patients, increased IgE titer had 48, 5% of patients, skin prick test was positive in 52, 6% infants. Rectal biopsies were performed in 40 patients (8 parents refused the procedure). Eosinophilic colitis (>15 eo/HPF) was found in 29/40 specimens (72.5%). A milk free diet was introduced in all patients and all improved. After at least 2 months of dietary regime, control biopsies were performed in 10 infants and improvement or normalization of the histological finding was observed in all of them. Three patients underwent the challenge test: in all the diagnosis of cow’ s milk allergy was confirmed both clinically and by elevated eo count in new biopsies. Conclusion: Among the tests performed in our patients, rectal biopsies were most informative in all cases (72, 5%), but not enough to be the exclusive diagnostic criterion. It is also worth mentioning that one child initially had a normal biopsy, but a convincing positive challenge test highlighted the diagnosis, confirming it to be the diagnostic“ gold standard” .

cow milk allergies

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