Cow’s milk protein allergy clinical spectrum and treatment outcome. Our experience at the children’s hospital Lahore,Pakistan

Objective: to determine the clinical spectrum and treatment outcome of cow’s milk protein allergy. patients and methods: cow milk protein allergy is a common disorder encountered in pediatric practice not only in outpatient department but also in inpatient. it’s easy and difficult to suspect owing to its protean manifestations ranging from simple prolonged diarrhea to skin manifestations respiratory or to severe failure to thrive. understanding of its various manifestations helps in early diagnosis and favorable outcome. we conducted this study in department of pediatric gastroenterology at the children’s hospital,lahore over a period of 18 months i-e from june 2015 to nov 2016. we included all patients less than 1 year of age which is the prime age of its presentation,with a history of 2 or more of the following symptoms lasting more than 2 weeks duration i-e loose stools,mucus & blood or occult blood in stool,straining,vomiting,reflux,colic,hematemesis,anemia,thrombocytosis or hypoalbuminemia. after diagnosis,based on symptoms and laboratory parameters described above patients were either started on exclusive breast feeding sometimes requiring restricting milk & milk products of the mother or prescribing alternate formula (soya/amino acid based formula). opinion from dermatology and pathology departments was taken wherever required. demographical profile and various factors described above were recorded in proforma. collected data was analyzed using spss version 20. results: our observation of commonest clinical feature was diarrhea in 84%,perianal rash 79.3%,mucus 73.6%,straining 70.8%,failure to thrive 53.8%,vomiting 41.5%,reflux 39.6%,skin manifestation 20.8%,respiratory 19.8%,least common was hematemesis in 12.3%. regarding investigations,hypochromic microcytic anemia was present in 91 (85.8%),thrombocytosis in 95 (89.6%),occult blood in 53 patients (50 %),albumin was significantly low (reference range 2.8-5.5 mg/dl) in 65 (61.3%) patients. conclusions: owing to wide range of clinical and lab parameters,clinicians must suspect cpma in patients with described signs and symptoms. © 2017,pakistan pediatric journal. all rights reserved.