Cow's milk allergy in the first year of life. An Italian Collaborative Study.

The diagnosis of Cow's Milk Protein Allergy was considered in 303 infants aged less than 1 year, who presented with one or more of the following symptoms: acute reaction related to cow's milk proteins (CMP) ingestion, severe colics, persisting vomiting, protracted diarrhea with or without blood and mucus, failure to thrive, eczema, respiratory symptoms, such as chronic rhinitis and wheezing. A diagnosis of CMPA was confirmed in 148 cases (60%): 125 relapsed on milk challenge, 23 were not challenged because of acute reactions at onset, presence of specific IgE (RAST and prick), and improvement on milk free diet. Familial atopy, familial history of CMPA and previous acute gastroenteritis were significantly more frequent in cases than in 191 age matched controls. Breast feeding was not more common or of longer duration in controls, compared to cases. Mean IgE serum levels were higher (46.3 U/ml) in cases than in controls (17 U/ml), while specific Cow's Milk Protein IgE were found in 71/148 cases (48%). 15 infants entered the study while on breast milk, because of the confirmed relation between their symptoms and CMP on the maternal diet. These infants had a higher prevalence of IgE mediated problems. All cases improved on a milk free diet but in 26 (17.8%) a further modification of the diet was required after the first prescription. Milk challenge was monitored by simple laboratory tests: all cases who had symptoms on challenge showed at least one test modification. Six infants, with no history of acute reaction, showed severe self-limited clinical symptoms at challenge. Key words: cow's milk allergy, milk, allergy, prick test, eczema, diarrhea.