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The Authors report an update relative to the dietetic prevention strategies in the high allergic risk subject, as proposed from more recent literature. The babies with a familiar history of atopia are defined as population with allergic risk. The Authors examine the role of early exposure to cow's milk formulas and maternal diet during breast-feeding as risk factors for allergic symptoms in such babies. Moreover, they examine the indications for hydrolisated milk (partial and extensive) formulas and soy milk formulas use, as reported in published Meta-analysis and official statements of several Scientific Associations. They conclude that beyond the undoubted preventive role of exclusive breast-feeding in the first 4-6 month after birth, and of the extensively hydrolisated formulas, there are many concerns about the role for partially hydrolisated formulas and soy formulas. The Authors claim for multicentric methodologically correct trials in order to clear the controversies.

Cow's milk protein is quite commune in infancy (2-3% in first year of age). Casein, beta-lactoglobulin and alpha-lactalbumin are the main allergens of cow's milk. The authors describe the immunological reaction involved in IgE synthesis and consequential inflammation after ingestion of cow's milk proteins and present soy and protein extensive hydrolysates as alternative diets for children with cow's milk allergy. Moreover, the authors present their studies on immunogenicity of hydrolysed formulae. At the end they suggest the therapeutic strategy in the cow's milk protein allergy.

Authors report their experience of a population of 308 children affected by cow's milk allergy who presented gastrointestinal, respiratory and cutaneous symptoms. Diagnosis was based on challenge with cow's milk proteins and on laboratory specific tests (RAST, prick test) and non specific ones (PRIST, eosinophil count, 1-h xylose test, occult blood in the stools), following ESPGAN criteria. The patients were subdivided in 3 groups: a) patients with prevalent gastrointestinal symptoms; b) patients with prevalent cutaneous symptoms and c) patients with both, gastrointestinal and cutaneous symptoms. The sensitivity of the employed tests was evaluated either in the whole patient population or in the there group according to symptoms. Our data show a high sensitivity of the RAST for cow's milk (70%) versus a lower sensitivity of prick test (53%) when the whole patients population was considered. Moreover statistically important differences of the sensitivity of the various tests were found when the three groups of patients were considered, as well as when such a comparison was done in patients subdivided according to age (more or less than 6 months). Finally the concord between RAST and prick test was evaluated in the three groups.

Pulmonary hemosiderosis (PH), a rare pathology, usually occurring during infancy and childhood, is characterized by numerous and repeated intra-alveolar bleedings, interstitial iron build-up with consequent progressive fibrosis and severe anemia. PH can be basically divided into 3 different categories: Primitive or idiopathic, involving a primitive deficit of antioxidizing enzymes in the erythrocytes in genetically predisposed subjects; Secondary, subsequent to chronic pneumopathy or cardiopathy; Associated with various pathologies including collagenopathies, glomerulonephritis, myocardiopathies, diabetes, steatorrhea, tireotossicosis. A particular type of Pulmonary Hemosiderosis, associated with allergy to cow's milk, has been described for the first time by Heiner. We present in this paper our personal experience of a young patient suffering from pulmonary hemosiderosis induced by cow's milk protein.

The authors describe a two months aged patient affected by cow's milk protein intolerance (CMPI) with serious haemorrhagic manifestations. As blood coagulative laboratory findings demonstrated a prolongation of P.T. and P.T.T. with a marked reduction of vitamin K-dependent factors only, the authors believe these bleeding manifestations secondary to a case of late haemorrhagic disease of the newborn. Vitamin K treatment determined a rapid normalization of haemorrhagic symptoms and laboratory clotting tests, without any alteration of these ones during the patient's follow-up too. The authors suggest that blood coagulative pattern must be investigated in all CMPI cases, especially in the ones with a precocious onset of clinical symptoms. In the cases with vitamin K-dependent factors deficiency the treatment is immediately necessary, while in other cases a daily dietary supplementation or a vitamin K weekly or monthly injection could be enough in order to prevent any further vitamin K-dependent factors deficiency.

Cow's milk protein intolerance (CMPI) is recognised as an important cause of protean symptoms in infants. There are no tests with enough specificity and sensibility to set up a diagnostic assay. We carried out preliminary study on children suffering from CMPI with the following aims: a) to ascertain the importance of the variation in circulating antibodies to cow's milk proteins in CMPI, b) to establish a useful screening tool to diagnose CMPI. Seventy-four subjects (s.) were studied and divided into four diagnostic groups as follows: Six s. (3 M, 3 F) suffering from CMPI mean age 4.8 +/- 3.9 months, assuming a diet containing cow's milk: I group. Eleven s. (O M, 7 F) suffering from CMPI mean age 7.8 +/- 4.6 months, assuming a cow's milk free diet, for several months (mean 4.5 +/- 1.5): II group. Nine s. (5 M, 4 F) suffering from enteropathies not cow's milk correlated, mean age 18.5 +/- 10.6 months, assuming a diet containing cow's milk: III group. Fourty-eight healthy s. (24 M, 24 F), mean age 10.5 +/- 4.3 months, assuming a diet containing cow's milk.(ABSTRACT TRUNCATED AT 250 WORDS)

A lactose-free soy and beef hydrolysate based formula ("Pregomin" Milupa) was studied in 12 infants affected with protracted enteritis and in 10 infants affected with atopic eczema. After 1 month of treatment with "Pregomin" an oral provocation test was performed using intact soy protein. The aim of this latter test was to evaluate if the hydrolysed soy formula could cause allergic sensitization to soy protein. We obtained the following results in the group of infants with enteritis: good catch-up growth, malnutrition laboratory test improvement, negative allergic tests, positive oral provocation test in only one infant who had been previously fed with intact soy protein. In the group with atopic eczema we found an improvement of the eczema, negative allergic tests, 3 out of 9 positive oral provocation tests (in infants previously fed with soy protein based formulas). Our data show that "Pregomin" formula was effective both from a gastroenterological point of view and from an allergological one. Furthermore we did not observe any positive oral provocation test with soy protein in infants who had never been exposed to this type of protein. The latter result seems to demonstrate that "Pregomin" formula does not possess any allergenic properties.

The authors report their own case-report about cow's milk protein intolerance observed in the last seven years in the gastroenterology-department of Pediatric Clinic in Pisa. They underline the symptomatologic polymorphism of the illness and, analysing the laboratory data, point out the absence of absolute diagnostic assurance tests. For this reason they conclude that at the present state the diagnosis of certainty is overall committed to the resolution of the symptomatology after exclusion-diet and following clinic relapse after milk load.

The authors report the main acquisitions from literature and their own experience concerning therapy of intolerance and allergy to cow's milk proteins, particularly referring to clinical gastrointestinal features. These points have been underlined: elimination diet is the most important step in therapy, even if intolerances to new aliments frequently arise (30% of cases), either when soy milk or hydrolysate formulas are used; pharmacologic agents inhibiting mediator release from the mast-cells thereby reducing gut permeability to macro-molecules (such as disodium cromoglycate) can be used as a "support" for a short period of time, but the drug can not replace the diet in the therapy; anyway, even if milk allergy may last for a long time, it is useful to test the possible acquired tolerance, beginning from the first year of life.

Food allergy (FA) (especially cow's milk allergy) is a frequent complaint in children. The clinical features of FA are protean and depend not only on the organ predisposition, but also on the immunological mechanism involved in the reaction. In this paper, the Authors review current knowledge regarding the clinical spectrum of FA in children, focusing the attention not only on classic clinical syndromes like anaphylaxis, atopic dermatitis and enteropathies, but also discussing less known problems like FA in breast feed infants, respiratory complaints, unusual gastrointestinal manifestations, cortical hyperostosis and also behavioural disturbances.

Cow's milk sensitive enteropathy has been described several times but in spite of that, it is still a problem concerning the pathogenesis. Our study involves the children hospitalized from 1974 to 1984 in the First Department of Pediatrics, University of Modena. Patients were suffering from chronic diarrhea and malabsorption. At the first biopsy each child showed atrophy of the small intestinal mucosa. All patients had been fed fed with gluten. We have followed the protocol for Celiac Disease's diagnosis; we found proved 85% of cases, excluded 15%. These last cases may be considered as cow's milk sensitive enteropathy. We catamnestically considered all the clinical and laboratory data of the two groups in the purpose of selecting significative parameters for a differential diagnosis. The data meaning fully different between the two groups resulted: family history of allergy, recurrent infections, positive occult blood in the stools, eosinophils in blood greater than 400/mm3 serum IgE value greater than 97 degrees P X (p less than 0.01). On the ground of recent studies the involvement of the cell-mediated immunity in cow's milk sensitive enteropathy is supposed.

Thirty children with cow's milk protein intolerance were submitted to skin tests with either alpha-lactalbumin and casein commercial products or substitutes commonly used for infant feeding. This method showed helpful in choosing the proper milk substitute for affected children.

The diagnosis of cow's milk proteins allergy can only be established if the symptoms disappear with an elimination diet and if a later controlled challenge leads either to a recurrence of symptoms or to some other clearly identified changes. At the moment there is not a specific immunological test surely effective in all cases. Anyway the three Gooldmann's tests are not necessary. In fact a single challenge with a cow's milk meal will be sufficient when clinical observation is accompanied by monitoring some simple laboratory tests (serum and nasal eosinophils, steathorrea, coproleucocytes, hemoccult, xylosemia and leucocytes PMN). The challenge must be tested in a double-blind trial only in patients with non specific symptoms (such as tension fatigue syndrome, hyperactivity, ecc...). The double-blind challenge is not necessary generally for the diagnosis of cow's milk proteins allergy in childhood, because at this time of life not only the symptoms are very clear (diarrhea, vomiting, skin symptoms) but also there is a prevalence of non reaginic reactions: this kind of reactions are usually delayed and they generally occur after a relatively high dose of food allergens. In the group of patients with specific anti-cow's milk IgE (RAST and prick tests) and severe reactions (anaphylaxis), the challenge is not necessary to confirm the diagnosis, but is usefully to verify the acquired tolerance, generally after the first year of life.

We performed a study concerning the relationship between hypertrophic pyloric stenosis (HPS), atopy and cow's milk protein allergy (CMPA). Familial history of atopy was documented in 17 (44.7%) of 38 infants having undergone Ramstedt pyloromyotomy for HPS, in 12 (23%) of 52 infants having undergone surgery for inguinal hernia and in 53 (26.9%) of 290 normal controls (significant differences between HPS and other groups). Moreover 9 (23.6%) of 38 infants with HPS presented personal history of eczema at follow-up compared with 3 (5.7%) infants having undergone surgery for inguinal hernia (p less than 0.01). A significant difference between HPS and other groups was also found when looking for familial history of CMPA: 26.3% vs % and 2.5% respectively (p less than 0.001). Eventually we discovered a higher than expected incidence of CMPA both in a retrospectively evaluated group of HPS and in 24 infants undergone Ramstedt pyloromyotomy and followed according to a standardized protocol for a mean period of 4 months (16.6%). The etiology of HPS remains obscure. Our data however suggest some relationship between HPS, atopy and particularly CMPA.