cow's milk protein allergy · 2020. 9. 28. · •cow's milk protein allergy is an immune system...
TRANSCRIPT
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Cow's milk protein allergy Rahaf Hasanein
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• Cow's Milk Protein Allergy is an immune system response to one or both of the proteins, Casein & Whey.
• Cow's Milk Protein Allergy (or CMPA) is the most common infant food allergy affecting 1.9% - 4.9% of infants worldwide.
• Tolerance in 50% of children by the age of 1 year, and in 80-90% by the age of 5 years.
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Types
1) The immunoglobulin E (IgE)-mediated type (Immediate reaction) Less than 2 Hours • Urticaria/hives • Wheezing • Rhinitis • Itching or a tingling feeling around the mouth or lips • Angioedema: swelling of the lips, tongue or throat • Coughing or shortness of breath • Vomiting • Anaphylaxis
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2) Non-IgE-mediated (Late reaction)
>= 2 Hours
• Atopic dermatitis
• Diarrhea
• Hematochezia
• Abdominal cramps
• Colic
• Vomiting, GERD
• Food refusal
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Food-protein induced enterocolitis syndrome(FPIES) • severe vomiting and diarrhea within 2-4 hours after ingestion of milk
causing profound dehydration, lethargy, and sometimes shock
• Chronic exposure my present with regurgitation, diarrhea, failure to thrive, and hypoalbuminemia
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Food protein-induced proctitis/proctocolitis
• bloody-streaked, mucousy, loose stools and occasionally diarrhea
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Food protein-induced enteropathy
• Protracted diarrhea in the first nine months of life, within weeks after introduction of milk. The majority of affected infants have failure to thrive, and some present with malabsorption.
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Heiner syndrome (food-induced pulmonary hemosiderosis)
• Cough, recurrent fever, wheezing, nasal congestion, recurrent otitis media, hemoptysis, failure to thrive, dyspnea, colic, anorexia, vomiting, diarrhea and hematochezia
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Diagnosis
1- Histoy and physical exam.
2- Diagnostic elemination and open challenge test.
3- other tests.
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Physical exam
• Wt and Ht.
• General exam/appearance.
• Signs of anemia.
• Respiratory and gastrointestinal exam.
• Blood in stool?
• Skin
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CMPA Lactose intelorance
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• If the infant is suspected of having IgE mediated CMPA, then a specific blood IgE level or skin prick test in a clinical setting is often used to aid diagnosis.
• In severe IgE-mediated CMPA Usually CMP is eliminated from the diet for 12-18 months and then the patient is rechallenged in a clinical setting. If the patient still has reactivity, the elimination diet is continued for another 6-12 months and the patient again is rechallenged.
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Other tests?
• Occult blood.
• CBC.
• Sigmoidoscopy if bleeding continued for more than 12 weeks after elimination.
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When re-challenge test is not done?
• Hx of anaphylactic shock.
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Thank you