Cow's milk protein allergy: a challenging diagnosis.

Cow's Milk Protein Allergy (CMPA) is the most common food allergy in infants. It can manifest itself through a wide variety of symptoms depending on the type of immune response is IgE or non-IgE mediated. In most cases acquisition of tolerance to cow's milk protein (CMP) occurs until the second year of life.To evaluate the cases of CMPA followed in our Outpatient Clinic of Pediatric Gastroenterology and compare IgE and non-IgE mediated CMPA.CMPA patients observed between December 1992 and December 2009 were included in this prospective study and followed-up according to our CMPA protocol.199 children were included in the protocol, but only 130 cases were confirmed the diagnoses of CMPA, 77 were IgE mediated (group A) and 53 non-IgE mediated (group B). Comparing the two groups, 45% vs 36% had positive family history of atopy. The median age of onset was 10 and six weeks respectively, and the interval between introduction of PLV into the diet and the onset of symptoms was four and five days. Infant formula was, in both groups, the main dairy product that triggered symptoms (71% vs 81%). In group A over half the children did the first dose of PLV in first 24 hours of life. The value of specific IgE to the major PLV was identified in 76 children and only 15.6% were positive. The most frequent symptoms in both groups were cutaneous (85.7% vs 50.6%), especially urticaria and angioedema, gastrointestinal symptoms (40% vs 38%), including vomiting and diarrhea.