Journal of Clinical and Diagnostic Research. 2012 May (Suppl-2), Vol-6(4): 615-618 615 615 ID: JCDR/2012/4130:0018 Original Article Cow’s Milk Protein Allergy in Infants and Their Response to Avoidance Key Words: Cow’s milk protein allergy, Infant, Avoidance, Atopy ABSTRACT Background: Cow’s milk Protein Allergy (CMPA) is the most common food allergy in infants and young children which affects 2% to 7.5% of the paediatric population. Although advanced immune regulatory medications were approved for the treatment, it seems that avoidance of cow’s milk derivatives is the most effective therapeutic plan. In this study, we evaluated cow’s milk protein allergy in infants with a positive family history and its response to the avoidance of cow’s milk derivatives. Methods: We conducted a cohort study on one hundred infants with the symptoms of CMPA who presented to the Najmiyeh Outpatients Clinic, Tehran, Iran, between 2008 and 2009. Other diagnoses were overruled and the CMPA treatment (avoidance of any cow’s milk derivatives) was recommended. The children were followed up after two weeks of undergoing the Allergen Avoidance Regimen (AAR) and the efficacy of the regimen was assessed. Results: Ninety three infants (mean age ± SD: 4.23±2.02 months, male: 54.8%) completed the study. A positive family history of atopy was observed in 77 (82.8%) children. Eighty eight infants (94.6%) showed a proper response to the AAR. There was no statistically significant correlation between the response to the AAR and the type of family history of the allergy, feeding and the clinical symptoms (P value of <0.05). Conclusion: The common age of incidence of CMPA was a period between 3 and 6 months and the common symptoms of it were gastrointestinal symptoms. Regardless of the family history of the allergy or the types of clinical symptoms; the AAR was effective on the patients. However, the prevalence of the failure to the AAR was considerable. INTRODUCTION Atopic diseases in infants and children have a prevalence of about 35%, which are the most important morbidity factors in industrialized countries [1-3]. Statistically, the incidence of these kinds of diseases is increasing and in western societies, it has been dramatically growing in recent decades [4]. 2.5%–15% of the infants show symptoms of cow’s milk protein allergy (CMPA) [5-7]. In exclusively breast-fed infants, the incidence of CMPA is only about 0.5%, perhaps up to 1.5% at the most [8-9]. From the patho-physiological point of view, CMPA may be caused due to IgE-mediated and non- IgE-mediated processes [10]. Both of them trigger the inflammatory cascade, leading to cytokine release and the enhanced production of other inflammatory products. Finally, the symptoms appear in various organs such as the lung and the gut. Complex immune interactions are the cause of a postponed attack of the clinical symptoms. The gastrointestinal symptoms of an allergic interaction (especially the non-IgE-mediated form) are specified by the presence of isolated, blood streaked stools. A distinction between these two groups (IgE-mediated and non-IgE- mediated allergy) can be recognized by other symptoms, but the medical history is not adequate for this. Making this distinction is very important because IgE-mediated CMPA is accompanied by a higher risk of multiple food allergies and atopic conditions [11-15]. From the clinical point of view, CMPA in infants usually show sym- ptoms which are similar to an allergic reaction in adults. These contain cutaneous symptoms such as skin rash, urticaria and pruritus, as well as respiratory symptoms such as cough and wheezing that are usually the symptoms of IgE-mediated CMPA [13]. In addition, CMPA may involve the gastrointestinal tract as a gastro- oesophageal reflux, showing the symptoms of delayed gastric emptying, colitis, gastritis, enteropathy, constipation and failure to thrive [14]. These symptoms may lead to paediatric colic and feed refusal in infants [16]. Various factors may contribute to the appearance of this allergy in infants such as diet, atopic symptoms and diseases, a family history of atopy, parental smoking, the number of siblings and furred household pets [17]. Although the incidence of the immunology based disorders have increased, the treatment of CMPA has progressed due to the developing medical technology. Although advanced immune regulatory medications were approved for the treatment, it seems that avoidance of cow’s milk derivatives is the most effective therapeutic plan. In this study, we evaluated cow’s milk protein allergy in infants with a positive family history and its response to the treatment. MATERIALS AND METHODS We conducted a cohort study on infants with CMPA symptoms who visited the Najmiyeh Outpatients Clinic, Tehran, Iran, between February 2008 and November 2009. At first, we enrolled all the infants who were suspected to have CMPA; thereafter, CMPA was confirmed by applying an elimination challenge test on these infants. Other diagnoses were overruled and the CMPA treatment was started for one hundred infants with a confirmed diagnosis CMPA. We assessed the patients for their demographic and clinical characterizations. The clinical signs and symptoms, a family history MOHAMMAD TORKAMAN, SUSAN AMIRSALARI, AMIN SABURI, SHAHLA AFSHARPAIMAN, ZOHREH KAVEHMANESH, FATEMEH BEIRAGHDAR, MOHSEN ALGHASI, HASAN KIANI Pediatrics Section