Epidemiology
1. Age: 0-10 months (usually presents 3 weeks - 3 months)
Pathophysiology
1. Cow's milk protein allergy
2. Concomitant soy milk allergy in 30% of infants
Predisposing factors
1. Early introduction of milk
  1. Especially after Gastroenteritis
Symptoms
1. Loose Bowel Movements
2. Blood and mucus streaked stools
3. Otherwise healthy infant with normal growth
4. Vomiting
5. Hives
Differential Diagnosis
1. Infectious colitis
  1. Salmonella
2. Enterocolitis due to NEC
3. Hirschsprung's Disease
Labs
1. Stool studies
  1. Leukocytes
  2. Stool Guaiac
  3. Stool Culture
  4. Wright's Stain for Eosinophils
2. Complete Blood Count with differential
  1. Eosinophilia
3. RAST testing not useful
Management
1. Nursing Mothers
  1. Avoid milk and possibly soy products in maternal diet
2. Formula fed
  1. Casein Hydrolysate formula (e.g. Nutramigen)
  2. Elemental formula (Neocate) for refractory cases
3. Re-challenge with milk at 1 year
Prognosis
1. Infants outgrow in 95% cases by age 1 year

Navigation Tree

Please see the Terms and Conditions. Please also see the privacy statement regarding advertising on this page. Although access to this page is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.