II. Epidemiology
- Age: 0-10 months (usually presents 3 weeks - 3 months)
III. Pathophysiology
- Distal colon inflammatory reaction to Cow's Milk Protein
- Appears to not be IgE mediated
- Concomitant soy milk reaction in 30% of infants
IV. Predisposing factors
- Early introduction of cow's milk
- Especially after Gastroenteritis
V. Symptoms
- Loose Bowel Movements
- Blood and mucus streaked stools
- Otherwise healthy infant with normal growth
- Vomiting
- Hives
VI. Differential Diagnosis
- Swallowed maternal blood (during delivery, or from cracked nipples)
- Most common cause of infants with blood in stool
- Infectious Colitis causing bloody stool (Salmonella, Shigella)
- Enterocolitis due to Necrotizing Enterocolitis
- Anal Fissure
- Hirschsprung's Disease
VII. Labs
-
Stool studies
- Leukocytes
- Stool Guaiac
- Stool Culture
- Wright's Stain for Eosinophils
- Complete Blood Count with differential
- RAST testing not useful
VIII. Management
- Nursing Mothers
- Avoid milk and possibly soy products in maternal diet
- Formula fed
- May trial on Soy Formula first (previously not recommended)
- Casein Hydrolysate formula (e.g. Nutramigen)
- Elemental formula (Neocate) for refractory cases
- Re-challenge with cow's milk at 1 year
IX. Prognosis
- Infants outgrow in 95% cases by age 1 year
X. References
- Mason and Woods in Herbert (2019) EM:Rap 19(2): 7-8
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Related Studies
| Concepts | Pathologic Function (T046) |
| SnomedCT | 197021003, 15911003 |
| Dutch | allergie voor koemelk, koemelkallergie |
| French | Allergie au lait de vache |
| German | Allergie gegen Kuhmilch, Kuhmilchallergie |
| Italian | Allergia al latte vaccino |
| Portuguese | Alergia a leite de vaca |
| Spanish | Alergia a la leche de vaca, alergia a la leche de vaca (trastorno), alergia a la leche de vaca, sensibilidad a la leche de vaca |
| Japanese | 牛乳アレルギー, ｷﾞｭｳﾆｭｳｱﾚﾙｷﾞｰ |
| English | Allergy to cow's milk, allergy cow's milk, cow's milk allergy, Cow's milk protein sensitivity, Cow's milk allergy, Cow's milk protein sensitivity (disorder) |
| Czech | Alergie na kravské mléko |
| Hungarian | Tehéntej allergia, Tehéntejallergia |
