Reviewed by Damien Downing MBBSThis 33-year-old paper has been extensively cited but its full implications are generally ignored. Much of what it says has been independently confirmed since but the study still stands out as an example of how much can be achieved by a perceptive physician using only his senses and his intellect-not large-scale clinical trials that can only be performed by large-scale research centres. It reports a paediatrician's experience with cow's milk allergy over a number of years. Basing the diagnosis on the golden standard of reaction plus elimination plus challenge, it describes a wide range of symptomatology.The author estimates that up to 3% of children display sensitivity to cow's milk during infancy-a figure which has recently been arrived at by several other researchers, although it is likely that incidences are rising. Of these children, only 50% tolerated goat's milk, but 95% accepted soya milk.The symptoms resulting from these allergic reactions were many and various, only about half being of the type normally associated with atopy. Any system in the body could be involved. Eczema 45% (Colic 31%) (Diarrhoea 23%)
Gastrointestinal (GI) problems 38%Upper respiratory Lower respiratory
13% 17%Cerebral 20%In each of these systems a range of symptoms was seen-for instance, as well as diarrhoea and colic, the GI problems encountered also included constipation, ulcerative colitis and coeliac syndromes. As well as eczema, urticaria and angio-neurotic oedema were seen. In the central nervous system, hyperkinesis and irritability were the commonest problems, but somnolence, apathy and hypokinesia were also seen. The point is made that anaphylaxis and even death could occur in exceptional cases. Perhaps the single most important observation, though, is that while the large majority of infants lost their allergic symptoms by the age of six, an estimated 80% of them developed other major allergic ailments before puberty. This finding, too, has since been confirmed by others, but it is all too easily forgotten by physicians, who still have the tendency to tell anxious mothers that their child will grow out of it, and to advise them therefore to do nothing in the way of treatment. 20 1 J Nutr Environ Med Downloaded from informahealthcare.com by University of Adelaide on 11/18/14For personal use only.
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