RELATIONS BETWEEN COW MILK ALLERGY,
GASTROEZOPHAGEAL REFLUX AND WHEEZING IN INFANTS AND SMALL CHILDREN
Banovcin P,
Jakusova L, Mikler J, Banovcin Pjr, Minarik M
Department
of Paediatrics, Faculty Hospital, Martin, Slovakia
Objective: Pathological gastroezophageal
reflux (GER) may present in infants and small children with various
symptoms. Its relation to repeated wheezing epizodes and bronchial asthma
is not clear. We have investigated the relation of the pathological GER to
wheezing epizodes in children from 6 to 24 months of age.
Methods: The diagnosis of
pathological GER was made by 24-hours ezophageal pH-metry and the presence
of allergy to the cow milk protein (CMA) has been assessed by complex of
investigations including prick test, sIgE, intestinal permeability test and
exposure test with cow milk. Infants with lactose intolerance have been
excluded. Student t-test has been used for statistical analysis.
Results: From 49 children with
repeated wheezing (at least 3 epizodes of wheezing, 21 boys, 18 girls, an
average age of 14,3 months) the pathological GER was found in 25 (51 %)
cases and the cow milk allergy was confirmed in 11 of them. Except for one
child, the pathological GER has been present in all cases of cow milk
allergy. All 11 children with CMA (group 1) have been started on
hydrolyzate formula and cow milk was stopped. 14 children with pathological
GER without CMA (group 2) have been on milk formula thickened with starch.
After 30 days on this diet we repeated the pH-metry and the pathological
GER was found in only 3 children in the group 1 and in 10 children in the
group 2 (p < 0,01). There has been also a significant difference in the
frequency of wheezing during 10 months observation period between both
groups. The average occurrence of wheezing during this period was 0,4
epizodes in the group 1 and 2,6 epizodes in the group 2.
Conclusion: We conclude, that cow
milk allergy may be the cause of pathological GER in infants and small
children and by GER or by another mechanisms it may also cause repeated
wheezing in children.