Cow’s Milk Protein Allergy in Children: An Observational Descriptive Retrospective Study

Background: Cow's Milk Protein Allergy (CMPA) is the most prevalent food allergy in children and is considered challenging to diagnose due to the diverse range of symptoms and lack of definitive tests. Objective: To identify the clinical manifestations of children diagnosed with CMPA and describe the macroscopic and histopathological findings during gastrointestinal endoscopy. Methods: A retrospective observational study was conducted at Tishreen University Hospital in Lattakia, Syria, over four years (2019-2022). The entry criteria were children diagnosed with CMPA. Selected cases underwent upper/lower gastrointestinal endoscopy. A positive result was defined as the presence of eosinophils (approximately 15-20 cells/high power field) in the histopathology while ruling out other potential causes of elevated eosinophils. Results: The study included 103 children. Endoscopic procedures with biopsies were performed in 61 patients. The results showed gastrointestinal symptoms, particularly vomiting, were the most common. General symptoms, such as failure to thrive and iron deficiency anemia, were also prevalent. Macroscopic manifestations of gastritis, such as congestion and edema, were frequently observed during upper gastrointestinal endoscopy. Additionally, 45.5% of cow's milk allergy patients exhibited visual nodular lymphatic hyperplasia during colonoscopy. Elevated eosinophils were found in 77.2% of colon biopsies and 75.4% of duodenal biopsies. Conclusion: This study recommends that conducting gastrointestinal endoscopy is beneficial for diagnosing challenging cases with various symptoms across different systems. Also, diluted gout milk proved an acceptable treatment option for underprivileged parents.