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Key Features

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  • Refers to nonallergic food sensitivity

  • More common in males than females and in young infants

  • Estimated prevalence is 0.5–1.0%

  • Exposure to cow's milk protein is from formula or breast milk

  • A family history of atopy is common

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Clinical Findings

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  • Symptoms may occur while an infant is still exclusively breastfed

  • Most common form is a healthy infant with flecks of blood in the stool or with loose mucoid stools with streaks of blood

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Diagnosis

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  • Skin testing is not reliable and not indicated

  • Histology, not required for diagnosis, shows mild lymphonodular hyperplasia, mucosal edema, and eosinophilia on rectal biopsy

  • In older children, milk protein sensitivity may induce

    • Eosinophilic gastroenteritis with protein-losing enteropathy

    • Iron deficiency

    • Hypoalbuminemia

    • Hypogammaglobulinemia

  • A celiac-like syndrome with villous atrophy, malabsorption, hypoalbuminemia, occult blood in the stool, and anemia can occur

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Treatment

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  • When symptoms are mild and the infant is thriving, no treatment may be needed

  • Otherwise, treatment consists of eliminating the source of the protein

  • In breastfed infants, maternal avoidance of milk protein usually suffices

  • In formula-fed infants, substituting a protein hydrolysate formula for cow's milk–based formula is indicated

  • A more severe form of food protein–induced enterocolitis syndrome (FPIES) may require corticosteroids

  • Allergic colitis in young infants is self-limited, usually disappearing by 8–12 months of age

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