Cows' milk protein-sensitive enteropathy. An important factor in prolonging diarrhoea of acute infective enteritis in early infancy.

Abstract

SUMMARY The possible role of cows' milk protein in prolonging diarrhoea in very young infants with acute infective enteritis was studied in 14 infants, 9 under the age of 2 months and 5 older than 6 months. Bacterial pathogens were isolated from the stools of 4 infants from the younger age group. After appropriate initial treatment the infants were maintained on a cows' milk protein-free formula. 6 weeks later jejunal biopsies were performed before and 24 hours after challenge with a low lactose cows' milk protein formula. The immunoglobulin and complement levels in the serum and duodenal juice were also estimated at these times. Attempts to isolate bacterial and viral pathogens in stools were again made in all patients. The 5 older infants clinically tolerated cows' milk protein and their pre-and postchallenge jejunal biopsies were within normal limits. However, significant histological changes were observed in the postchallenge jejunal biopsies of all 9 infants under 2 months of age. In addition, 5 of these infants developed diarrhoea. This suggests that the jejunal mucosa of very young infants previously fed a cows' milk protein-based formula and who contract infective enteritis suffers damage when rechallenged with cows' milk protein.

Early and Late Effects of Breast-Feeding: Does Breast-Feeding Really Matter?

“…The rationale for protection by exclusive breast-feeding for at least 3 months [95] or longer [93] is provided by the hypothesis that sensitization and development of antibodies to a 17-amino-acid cow's milk protein that reacts with a beta cell surface protein (p69) might be the initial step in the etiology of IDDM [99]. Kostraba et al [95] propose that sensitization could occur either by very early exposure to cow's milk, before the closure of intestinal enterocyte tight junctions, or exposure to cow's milk during periods when the intestinal barrier is compromised (such as gastrointestinal infection), allowing antigens to cross and initiate an immune reaction [100]. Human milk contains growth factors and hormones that may promote gut closure [14], and, as discussed in the first section of this chapter, exclusive breastfeeding lowers the incidence of gastrointestinal infections, thus exposure to the cow's milk epitope associated with IDDM would be reduced not only because of absence of cow's milk feeding, but also because of maintenance of the gastrointestinal barrier even during later periods of partial breast-feeding.…”

Leucocyte Migration Inhibition in Cow's Milk Protein Intolerance

“…There is a paucity of published literature on the extent of this problem in developing countries. Recent reports suggested it to be a common cause of infantile protracted diarrhoea in developing countries (2,3).…”

Diagnosis of Food Allergy

“…Although the most common causal food of FPE is cow’s milk, other foods such as soy, egg, rice, poultry, fish, and shellfish have been described 81–83 . FPE can also occur after acute episodes of infectious gastroenteritis 84,85 .…”