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Persistent cow's milk protein intolerance in infants: the changing faces of the same disease


Carroccio via Coffaro 25, 90124 Palermo, Italy.



Recent research has shown that cow's milk protein intolerance (CMPI) often persists beyond 4 years of age.


To evaluate the clinical and immunological characteristics of a group of infants with persistent CMPI.

Patients and methods

Twelve infants (6 m, 6f) with persistent CMPI were followed up from birth until a median age of 5 years. The patients underwent CMP challenge each year to evaluate CMP-tolerance. As controls we followed 26 infants (12 m, 14 f) with CMPI that resolved within 1–2 years.


A family history of atopic disease was found in 10/12 patients with persistent CMPI and in 10/26 controls (< 0.01). Clinical presentation changed over time: at onset symptoms were prevalently gastrointestinal, while at the end of the study there was an increased frequency of wheezing and constipation and a higher frequency of delayed reactions to CMP-challenge than at study commencement (9/12 vs 2/12; < 0.007). 11/12 infants with persistent CMPI and 3/26 controls (P < 0.0001) presented multiple food intolerance. During the observation period 9/12 infants with persistent CMPI and 2/26 controls showed atopic disease: asthma, rhinitis, eczema (P < 0.0001).


Persistent CMPI forms are characterized by: (a) considerable importance of familial atopic disease; (b) change in CMPI manifestations over time and more prolonged delay between CMP consumption and manifestation of symptoms; (c) very high frequency of multiple food intolerance and allergic diseases.

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