Food allergy in the first 6 months of life – clinical aspects

Abstract

Introduction. Food allergies are increasingly more frequent all over the world, in most cases with childhood onset. Cow’s milk protein allergy (CMPA) is the most frequent allergy in infants. Clinical manifestations are nonspecific and can affect the skin, digestive tract, respiratory system or can be systemic. Oral challenge test is the gold standard diagnostic test and the treatment is the exclusion diet. Material and method. Between June 2014 and December 2017 we conducted a prospective study in which 179 infants were included. They had been hospitalized in the Pediatrics Department of “Grigore Alexandrescu” Emergency Clinical Hospital for Children with suggestive symptoms for food allergy before the age of 6 months. Results. The final study group consisted of 161 infants, because in 18 cases food allergy was excluded. 95% of infants had cow’s milk protein allergy (CMPA). The average age of the symptom’s onset was 2.3 months. 27.2% of infants had acute allergic reaction like moderate-severe forms of acute urticaria or Quincke oedema (angioedema). 2/3 of infants from the study group had late clinical manifestation of CMPA: vomiting (32.3%), food refusal (30.4%), bloody stools (27.3%) and poor weight growth (34.1%). Approximately one third of the infants associated moderatesevere forms of gastroesophageal reflux, unresponsive to treatment. 48% of infants had IgE mediated cow’s milk protein allergy and 52% had non-IgE mediated allergy. Only 41% of infants from the group study were exclusively breastfed at 3 months of age and one third of them had an acute allergic reaction when a milk formula was introduced. Cow’s milk protein introduction after the exclusion diet was made at 9,6 months for the breastfed group and at 13 months for the group fed with formula. Conclusions. Food allergy diagnosis requires a high degree of suspicion from the pediatrician, as the predominant gastro-intestinal symptoms are non-specific and non-IgE mediated. The nutrition in the first months of life has an important impact in allergic diseases.

Keywords

• infant
• cow milk allergy
• acute allergic reaction
• late allergic reaction
• digestive manifestations