In children between 4-10 years diagnosed with cow's milk protein allergy examination of gastrointestinal symptoms

Objective: The frequency of foodallergy in childhood has beenreported as 4,5- 6% and cow's milk protein allergy has been reported at different frequencies up to 1,8- 7,5%. It is important to make a correct diagnosis in cow'smilk protein allergy (CMPA) in order not to make unnecessary elimination diet restrictions in children who are in the growth and development period. The aim of our study was to evaluate the gastrointestinal symptoms and to determine the incidence of functional bowel diseases in children followed up with the diagnosis of cow's milk protein allergy. Materials and Methods: Our study was carried out on 61 children aged between 4 and 10 who were followed up with the diagnosis of cow's milk protein allergy in Dokuz Eylül University Nevvar Salih İşgören Children's Hospital, Department of Pediatric Allergy and Immunology between 2015 and 2017 and can tolerate and consume cow's milk. In order to determine the presence of gastrointestinal symptoms, the prevalence of functional gastrointestinal diseases, the risk factors affecting these diseases, and to reveal the demographic characteristics of these children, the Pediatric Gastrointestinal Symptoms Questionnaire, which includes the Rome III criteria, was applied by interviewing the families of the pediatric patients face-to-face, by telephone or e-mail. In addition, laboratory findings of children (skin prick test, total IgE, complete blood count) were obtained from patient files and hospital system records. Results: The children included in the study, 35 (57,4%) were boys and 26 (42,6%) were girls. The mean age of the children was 5,9 ± 1,3 years, with a median of6(4–10). Skin prick test (DPT) results of 47 (%77) children were obtained. The skin vi prick tests of 31 (50,8%) of them were positive (3 mm and above). As a result of studies conducted on 61 children, functional gastrointestinal disease was found in 19 children (31,1%). As a result of this study, 3 children with irritable bowel syndrome (4,9%), 3 children with functional abdominal pain (4,9%), 8 children with functional constipation (13%), 1 child with cyclic vomiting syndrome (1,6%), and 9 children with a diagnosis of functional dyspepsia (14,7%) was made. More than one functional gastrointestinal disease was found in 5 (26%) of the diagnosed children. Abdominal pain was detected in 42% of the patients. The children with abdominal pain, 58% described the upper and lower abdomen as the location of the pain, 19% described lower abdominal pain, and 23% described upper abdominal pain. It was observed that 34% of the children had their abdominal pain regressed or disappeared with defecation. When the skin prick test positivity, eosinophil and total IgE elevation were compared with the abdominal pain findings of the patients, the results of the chi-square tests were found to be above 0,05. Based on this, it was understood that there was no relationship between skin prick test positivity, eosinophil and total IgE elevation, abdominal pain and gender. When the frequency of side effects in the patients was compared, upper abdominal pain in 34,4%, lower abdominal pain in 32,2%, stool incontinence in 44,3%, constipation in 34%, belching in 70,5%, flatulence in 93,4%, abdominal tension in 29,5%, gurgling (swallowing air) in 16,4%, vomiting in 19,7%, regurgitation in 21,3% were observed. Conclusion: Functional gastrointestinal disease was detected in 31,1% of the patients followed up with the diagnosis of cow's milk protein allergy. When this situation is compared with the literature, it can be said that it is generally similar to the society, but as a result of the studies and our study, cow's milk protein allergy is an important risk factor for these diseases. Questioning gastrointestinal symptoms in patients followed up with a diagnosis of food allergy in pediatric allergy out patient clinics will provide an important benefit in many respects in the long run. Keywords: Cow's milk protein allergy, functional gastrointestinal disease, Rome III criteria