A320 COW MILK PROTEIN ALLERGY - THE GREAT MASQUERADER
Notice bibliographique
Résumé
Cow milk protein allergy is a very common disease, with a prevalence of 2 to 7.5% in the pediatric population. The diagnosis is often made clinically and appears early, usually during the first few months of life. Common clinical presentations include: reflux, atopic dermatitis, failure to thrive, chronic diarrhea, as well as rectal bleeding or enterocolitis. Severe, life-threatening, presentations are very rare.The 2 reported cases show that cow milk protein allergy may have a very early and severe presentation and can even mimic some surgical diagnoses. Case n°1 An 8-day-old formula-fed male infant with no significant personal or family history of atopic disease was transferred to our hospital with bilious vomiting and abundant hematochezia. Small intestinal volvulus was suspected, but laparotomy was normal. In the face of persistent rectal bleeding and severe anemia (Hgb 73g/l), rectal biopsy and upper endoscopy were performed and showed mild colitis and severe gastritis with mucosal desquamation. Biopsies revealed an important infiltration of eosinophilic cells (>100/HPF in the stomach and severe eosinophilic proctitis). Peripheral eosinophil count was initially normal, but hypereosinophilia appeared at day 3 of admission (maximum 2600 106/L at 16 daysof life). After 8 days of bowel rest with total parenteral nutrition, progressive refeeding was initiated, with an amino acid based formula and was well tolerated. Case n°2 A newborn female infant was transferred to our hospital for suspected intestinal obstruction. She was breastfed and had a brother with cow’s milk protein allergy. She presented with bilious emesis and mild rectal bleeding a few hours after birth. Abdominal X-ray showed small bowel dilatation. Ultrasound and small bowel opacification did not demonstrate volvulus or malrotation. Enteral feeding was started with standard formula 48 hours after admission.Three days later, she suddenly deteriorated and developed acute diarrhea with hypernatremic dehydration (Na: 165mmol/l) and metabolic acidosis (pH: 7.145, bicarbonate level: 11mmol/l). Feedings were stopped but 24 hours later she once again developed rectal bleeding. A severe colitis was seen on endoscopy and biopsies showed eosinophilic infiltration of the mucosae with >70 eosinophils/HPF. Rectal bleeding stopped 3 days after she was made NPO. Peripheral eosinophilia (max 3000 106/L) appeared at day 6 of life. She responded well to an amino acid based formula and peripheral hypereosinophilia resolved. The above cases show that cow milk protein allergy can have an acute and severe presentation and can even mimic surgical pathologies in early life. Atypical clinical manifestations of cow milk protein allergy need to be recognized by pediatricians and primary care physicians in order to improve the management of these patients. Ste Justine Fundation
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».