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Master Thesis

Devenir à moyen et long terme des enfants allergiques aux protéines du lait de vache

Abstract : Objectives: To describe the medium and long-term outcome of children with cow's milk protein allergy (CMPA). Methods: Among the 434 children followed for suspected CMPA at the University Hospital of Grenoble from January 1990 to August 2009, 192 children were considered to have a "proved" cow's milk protein allergy (according to clinical criteria, laboratory findings and oral food challenge). More than 80% answered to our telephone interview. Results: Sixty five per cent have a family history of atopy. The median age at diagnosis is 3,25 months [0 to 16]. The median age at the latest news is 8,6 years [0,4 to 23,3]. According to a negative oral food challenge and evolution, 91,1% of patients became tolerant to cow's milk proteins (median age 23 months). Using Kaplan Meier method, the cumulative probability of achieving tolerance is 26,3% at 15 months, 50,5% at 24 months, 75,8% at 42 months and 97% at 16 years. Tolerance occurs later in children with IgE mediated allergy (p=0,0017). Weight and Height/Length for age (Z scores) and Weight for Height/Length improved from diagnosis to the latest news. Among the 143 children considered to be tolerant who replied, only 50.3% eat currently dairy products without restriction. Among the 192 patients of the study, 118 (61.5%) had a clinical allergic reaction and/or sensitization to other food which has led to an elimination diet. These foods are egg, nuts, fish, wheat, soybeans and shellfish. At the time of latest news, 27 children (14.1 %) have developed eczema and 66 urticaria (34.4%). This rate is 26.6% (51 children) for rhinitis and 34.4% (66 subjects) for conjunctivitis. An amount of 77 children (40.1%) experienced asthma or wheezing. The cumulative probability of developing asthma was 27.4% at 3 years and 49% at 10 years. Conclusion: This study involved a large cohort of children with cow's milk protein allergy. We conclude that most of them achieve tolerance during early childhood. But they are more likely than other children to develop other symptoms of allergic spectrum. The outcome is different whether the allergy is IgE mediated or not. It is valuable for clinicians to learn about the natural course of the "allergic disease" in order to prevent and detect the development of other atopic disorders. This knowledge could also be useful to inform more accurately the patients and their families.
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Master Thesis
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Submitted on : Thursday, September 15, 2011 - 5:32:58 PM
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  • HAL Id : dumas-00624117, version 1

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Marie Baret. Devenir à moyen et long terme des enfants allergiques aux protéines du lait de vache. Médecine humaine et pathologie. 2011. ⟨dumas-00624117⟩

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