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We agree wholeheartedly with the comments made by Drs. Deamer and Sandberg1 referring to the article by Dr. Øster.2 Recurrent abdominal pain with and without chronic or intermittent diarrhea is a very common manifestation of intolerance to dietary proteins or "food allergy." In our experience, the most frequent offending proteins are milk proteins, soy proteins (various soy-protein formulas, also present in candy bars), and related leguminous proteins, as well as corn and the citrus family.

7 infants, aged 5 weeks to 11 months, with clinically documented intolerance to cow’s milk protein, chronic diarrhea, and failure to thrive, underwent small intestinal (peroral, suction) biopsy before and after withdrawal of milk proteins. Mucosal specimens were examined by light microscopy and assayed for disaccharidase activities. In all patients, moderate to severe mucosal changes were present, associated with marked inflammation of the lamina propria and damage to the brushborder. Disaccharidase activities (lactase, sucrase, maltase and palatinase) were markedly depressed in all. Follow-up biopsies were obtained in 6 infants, after 3–5 months on a milk-protein-free diet. At the time of the second biopsy, the disaccharidase activities had risen significantly and histologic improvement had occurred in each instance. In infancy, intestinal mucosal lesions due to intolerance to cow’s milk protein are histologically indistinguishable from those seen in gluten-sensitive enteropathy and are associated with marked secondary disaccharidase deficiencies. Following therapy, the activity of the disaccharidases become normal or near normal prior to the complete morphologic recovery of the small intestinal mucosa.

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