All issues > Volume 38(11); 1995

Original Article

J Korean Pediatr Soc. 1995;38(11):1515-1524. Published online November 15, 1995.

A Follow-Up Study of Intractable Diarrhea in Early Infancy: Clinical Features of Cow's Milk Allergy and Cow Milk-Sensitive Enteropathy

Young Rak YR Kwon¹, Young Ho YH Ahn¹, Jin Bok JB Hwang¹, Chang Ho CH Han¹, Hai Lee HL Chung¹, Young Dae YD Kwon¹

¹Department of Pediatrics, Taegu Catholic University School of Medicine, Taegu, Korea

Abstract

Purpose
: The multiplicity of poorly defined illnesses and the variability of clinical and laboratory features elicited by milk ingestion in sensitized infants has made it difficult to differentiate them from the more common forms of cow milk intolerance. Following up the cases of intractable diarrhea in early infancy(illI), We investigated the clinical features of cow's milk allergy(CMA) and cow milk-sensitive enteropathy(CMSE) and observed the development of clinical tolerance with cow's or soy-based milk formula in patients suffering from illr.
Methods
: We reviewed the clinical records of patients who had been admitted and diagnosed as illI at department of pediatrics, Taegu Catholic University Hospital from March 1992 to May 1994. All of them were being fed with protein hydrolysate at the time of discharge from hospital. Twenty-eight infants of them returned to be followed.
Results
: 1) Although the body weight at birth of the patients was 3124¡¾540(2740-3890)gm, all on admission was below 3 percentile in body weight. Fifteen of 18 patients were 25-75 percentile at 6 months of age, nine of 19 patients were over 75 percentile at 12 months of age. 2) The development of clinical tolerance in soy-based formulu was null at 2 months of age, 36% at 4 months of age, 72% at 6 months of age, 72% at 10 months of age and 100% at 12 months of age. The tolerance rate in cow's milk formula was null at 2 or 4 months of age, 33% at 6 months of age, 62% at 10 months of age and 91 % at 12 months of age. Tolerance rate increased sharply at 6 months of age. Most of all patients tolerated within 12 months of age. 3) The forty-four adverse reactions after challenge were not different between soy-based and cow's milk formula. Gastrointestinal disturbances were major manifestations of challenge as vomiting(85%), irritability or colid62%), diarrhea(54%), pallor or lethargy(46%), hematemesis or melena(30%), abdominal distention(23%). Wheal like rash on the trunk was developed in 3 reactions(7%). Respiratory symptoms were not developed. Symptoms were noted from 1 to 24 hours after challenge in 41 reactions(93%). Three reactions(7%) responded within 1 hours after challenge. 4) Immunologic studies showed that 10 of 24 patients(41%) were positive for IgE RAST and were significantly correlated with the increase of total serum IgE and numbers of eosinophils in the peripheral blood smear(p<0.05). Skin prick tests were positive in 8 of 18 cases(44%). 5) Family allergy histories were observed in 9 of 28 patients(32%). Nine of 28 patients(32%) showed rhinitis, urticaria or asthma through follow-up interview. Maternal milk intake over 250cc per day in the third trimester was noted in 16 of 28 patients(57%), in 11 of 42 controls(27%)(p<0.05). 6) Stool frequency in patients fed with protein hydrolysate was 4.6¡¾2.H1-10) and mucoid stool was noted in 16 of 28 cases(57%).
Conclusion
: The development of clinical tolerance in cow's and soy-based milk formula was sharply increased at 6 months of age. Most of all tolerated within 12 months of age. CMSE is more frequent than perviously reported and always temporary disorder of infancy. We thought that reintroduction of normal diet is nearly always possible within 12 months of age.

Keywords :Cow's milk allergy, Cow milk-sensitive enteropathy, Early infancy, In­ tractable diarrhea, Protein hydrolysate