الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The incidence of CMPA in infancy seems to be approximately 2 to 6% in developed countries. CMPA develops in early infancy, rarely after 12 months of age. The onset of disease is in most cases closely related to the time of introduction of cow’s milk products.
Diagnosing cow’s milk protein allergy in a child is a challenging task. The overall prognosis of CMPA in infancy is good with an overall remission rate of approximately 85 to 90% at 3 years and a remission of 100% of gastrointestinal symptoms. Children with non–IgE-mediated reactions to CM have been shown to recover earlier than those with IgE-mediated reactions but other factors promoting the development of tolerance remain unclear.
Because food allergy might put children at risk for inadequate nutrition, children and their caregivers can consult with a dietitian to create a nutritionally adequate, allergen-free diet.
The aim of this study is to elucidate the clinical course of CMA, as well as the factors promoting or hindering the development of tolerance to CM. This would help the health care providers through using knowledge of the natural history of the disease to expect when would the child outgrow the allergy, this also would help them to take the decision on when to assess for resolution by performing an oral food challenge.
This study included total number of 95 children who were confirmed to have CMPA. Recruited patients aged from 1 months till three years of age.
In the present study there was no significant difference in gender distribution of cases observed among the studied group .Family history of allergy was found in more than half of the infants. The majority of infants were formula fed, while only 18.95% were exclusively breastfed.
The majority of our patients presented with chronic symptoms while 11.57% of them presented with acute symptoms. The spectrum of clinical presentation was variable. All the patients presented with gastrointestinal manifestation, possibly due to the fact that patients were referred to pediatric gastroenterology clinic. Diarrhea was the commonest symptom. It was present in 90.53% of infants. Excessive regurgitation and vomiting were the second common symptoms occurred in 71.58% of the infants. Colics were present in 67.37% of infants and only 7.37% of the infants presented with constipation.
All infants diagnosed with CMPA were treated by elimination of cow’s milk products from their diets. This was done by elimination of milk and all forms of dairy products from the mother’s diet in exclusively breast-fed infants. Most of the formula fed infants were shifted to amino acid based formula. However, non-adherence to complete elimination of cow’s milk protein in the diet was reported in 11 cases.
Children were tested for tolerance acquisition to CMP after a period of 6 to 9 months elimination of CMP from their diets. Of 95 infants who were recruited in the study, 60 infants (68.42%) acquired tolerance to CMP, while 35 infants (36.84%) didn’t acquire tolerance with reappearance of clinical symptoms after reintroduction of cow milk in their diet.
The possible risk factors that are associated with delayed tolerance to cow’s milk protein in infants and children with CMPA were studied and analyzed.
We found that IgE mediated CMPA, FPIES and CMPA-associated eosinophilic GI disorders have a poor prognosis when compared with other types of CMPA. Regardless of the mechanism of CMPA, delayed diagnosis, multiple involved body systems, poor compliance on milk elimination diet and multiple food allergies are associated with delayed tolerance and persistent CMPA to older age.
Most infants with food protein induced proctocolitis acquired tolerance to CMP earlier than children with food protein induced enterocolitis.
Patients with non-IgE mediated CMPA had the highest rate of tolerance (75%), while those with IgE-mediated and mixed (eosinophilic) type of CMPA had lower rates. Factors that can predict delayed acquisition of tolerance to CMP were studied again in children with non IgE mediated CMPA. It was found that rural residence, delayed diagnosis, non-compliance to elimination diet and multiple food allergy are associated with delayed tolerance acquisition and that was statistically significant.