Assessment of IgE-Mediated and Non-IgE-Mediated Cow’s Milk Protein Allergy in Children

Cow’s milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth.

In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta.

The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow’s Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed.

We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), the remaining (17,5%) being represented by exclusively breastfed infants. The most frequent clinical manifestations were rashes (87,5%), failure to thrive (82,5%), regurgitation (50%) and diarrhea (35%).

Further data should be collected to prove if the association between a CoMiSS score higher than 12 and specific IgE-mediated CMPA is clinically relevant, and can predict, based on clinical examination and anamnesis, high serum levels of specific immunoglobulin E.

The prognosis can depend on the titre of specific IgE at the time of diagnosis, as they are more likely to develop several crossed allergies and less prone to become tolerant to cow milk proteins than those with non-IgE-mediated CMPA.