Cow's milk protein intolerance in infants under 1 year of age: A prospective epidemiological study

Abstract

Incidence and clinical manifestation of cow's milk protein intolerance (CMPI) were studied in 1158 unselected newborn infants followed prospectively from birth to 1 year of age. No food changes were required in 914 infants who were used as healthy controls. When CMPI was suspected (211 infants), diagnostic dietary interventions according to a standard protocol were performed. After exclusion of lactose intolerance, two positive cow's milk elimination/challenge tests were considered diagnostic of CMPI. Two hundred and eleven symptomatic infants were examined for possible CMPI. A large group of 80 infants improved on a lactose reduced formula. In 87/211 infants CMPI was excluded (sick controls). Finally CMPI was proven in 26 infants. The calculated incidence rate for CMPI was 2.8%. The principal symptoms in infants with CMPI were gastrointestinal, dermatological and respiratory in 50%, 31% and 19% respectively. A positive family history for atopy (first or second degree relatives) was more frequent in either CMPI infants (65%), or sick controls (63%) when compared to either healthy controls (35%) or infants improving on a low lactose formula (51%). Differences between patients with CMPI and sick controls were only found for the presence of atopy in at least 2 first degree relatives [(5/26 in CMPI infants and 4/87 in sick controls (P < 0.05)] and for multiorgan involvement [10/26 infants with CMPI as opposed to 12/87 in the sick control group (P < 0.02)]. These statistical differences are too weak to be of clinical value.

Milk hypersensitivity in young adults

“…The prevalence of milk hypersensitivity can then be estimated to be between 13 ± 23 out of 406, or 3 ± 6%. This compares well with the prevalence of cow milk allergy in children under the age of three which is reported to vary between 2.2 ± 3.5% (Hùst & Halken, 1990;Savilahti et al, 1991;Schrander et al, 1993). On the other hand, also other groups than B and C may include milkhypersensitive subjects who have not connected their symptoms to milk or are both lactose-intolerant and milkhypersensitive.…”

“…Milk hypersensitivity is mediated by immunological mechanisms. About 3% of infants suffer from cow milk allergy (Hùst & Halken, 1990;Savilahti et al, 1991;Schrander et al, 1993). Most of them have been reported to become symptom-free by the age of three (Hùst & Halken, 1990), and milk hypersensitivity is therefore considered rare among adults.…”

Heretical thoughts about food hypersensitivity: small bowel manometry as an objective way to document gut reactions

“…Although the self-reported frequency of adverse food reactions is 10±20% in surveys of random populations, objective testing substantiates that diagnosis in less than 2% of people who complain of such disturbances (Niestijl Jansen et al, 1994;Sloan & Powers, 1986). Similarly prospective studies in children with complaint of`food problems' disclosed rates of 2.2±8% true allergies (Schrander et al, 1993). Moreover, the dif®culty of de®ning the prevalence of food allergy is increased by the variations in patient ages, diagnostic criteria, recruitment bias and cultural differences in eating patterns (Eigenmann & Sampson, 1994).…”

The Progress of Food Allergy Concept, Classifications and Diagnosis

“…The prevalence of sensitization to the specific food allergens varies based on the age and characteristics of the population, but studies incorporating diagnostic food challenges currently estimate that the prevalence of cow's milk allergy in infants is 2.5%, egg hypersensitivity prevalence in young children is 1.6% and peanut allergy is estimated to be between 0.8 and 1.5% in young children in US and England. [22][23].…”