Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 10139

AbstractMaterial and MethodsResultsDiscussionAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 615 - 618

Cow’s Milk Protein Allergy in Infants and Their Response to Avoidance

Mohammad Torkaman, Susan Amirsalari, Amin Saburi, Shahla Afsharpaiman, Zohreh Kavehmanesh, Fatemeh Beiraghdar, Mohsen Alghasi, Hasan Kiani

1. Faculty of Medicine, Paediatric department, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 2. Faculty of Medicine, Paediatric department, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 3. Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 4. Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 5. Faculty of Medicine, Paediatric Department, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 6. Faculty of Medicine, Paediatric Department, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 7. Student Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. 8. Student Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran.

Correspondence Address :
Susan Amirsalari
Associate Professor of Paediatric Neurology,
Baqiyatallah University of Medical Science,
Mollasadra St, Vanak Sq, Tehran, I.R.Iran.
Tel/Fax: 009821-88600062.
E-mail: aminsaburi@yahoo.com

Abstract

(1) Zmijewski Chester M., Haesler Walter E. Blood Banking Science. New York: Appleton Century Croft; 1982. (2) An action plan for blood safety. National AIDS control organization: Ministry of Health and Family Welfare, Government of India. 2003. Jul; 7. (3) Management of blood transfusion services, WHO 1990. (4) The World Health Organization 1211 Geneva 27, Blood safety and clinical technology progress 2000-2001. (5) Gupta A. The status of blood banking in India. Health Millions. 2000 Mar–Apr;26(2):35–8. (6) Blood Centres in South - East Asia. Available from:http://www.dialog. lk/corporate/media_mediaApril2003_2.html. (7) Gilani I, Kayani ZA, Atique M. The knowledge, attitude and practices (KAP) regarding blood donation which are prevalent in medical and paramedical personnel. J Coll Physicians Surg Pak. 2007 Aug;17(8): 473-76. (8) Shenga N, Pal R, Sengupta S. Behavior disparities towards blood donation in Sikkim, India. Asian J Transfusion Sci. 2008 July; 2(2): 56–60. (9) Hosain GM, Anisuzzaman M, Begum A. The knowledge and attitude towards voluntary blood donation among Dhaka University students in Bangladesh. East Afr Med J. 1997;74:549–53. (10) Juárez-Ocaña S, Pizaña-Venegas JL, Farfán-Canto JM, Espinosa- Acevedo FJ, Fajardo-Gutiérrez A. Factors that influenced the non donation of blood in the relatives of patients at a pediatric hospital. Gac Med Mex. 2001;137:315-22.

Keywords

Cow’s milk protein allergy, Infant, Avoidance, Atopy

Introduction
Atopic diseases in infants and children have a prevalence of about 35%, which are the most important morbidity factors in industrialized countries [1-3]. Statistically, the incidence of these kinds of diseases is increasing and in western societies, it has been dramatically growing in recent decades (4). 2.5%–15% of the infants show symptoms of cow’s milk protein allergy (CMPA) [5-7]. In exclusively breast-fed infants, the incidence of CMPA is only about 0.5%, perhaps up to 1.5% at the most [8-9]. From the patho-physiological point of view, CMPA may be caused due to IgE-mediated and non- IgE-mediated processes (10). Both of them trigger the inflammatory cascade, leading to cytokine release and the enhanced production of other inflammatory products. Finally, the symptoms appear in various organs such as the lung and the gut. Complex immune interactions are the cause of a postponed attack of the clinical symptoms. The gastrointestinal symptoms of an allergic interaction (especially the non-IgE-mediated form) are specified by the presence of isolated, blood streaked stools. A distinction between these two groups (IgE-mediated and non-IgEmediated allergy) can be recognized by other symptoms, but the medical history is not adequate for this. Making this distinction is very important because IgE-mediated CMPA is accompanied by a higher risk of multiple food allergies and atopic conditions [11-15]. From the clinical point of view, CMPA in infants usually show symptoms which are similar to an allergic reaction in adults. These contain cutaneous symptoms such as skin rash, urticaria and pruritus, as well as respiratory symptoms such as cough and wheezing that are usually the symptoms of IgE-mediated CMPA (13).

In addition, CMPA may involve the gastrointestinal tract as a gastrooesophageal reflux, showing the symptoms of delayed gastric emptying, colitis, gastritis, enteropathy, constipation and failure to thrive (14). These symptoms may lead to paediatric colic and feed refusal in infants (16). Various factors may contribute to the appearance of this allergy in infants such as diet, atopic symptoms and diseases, a family history of atopy, parental smoking, the number of siblings and furred household pets (17). Although the incidence of the immunology based disorders have increased, the treatment of CMPA has progressed due to the developing medical technology. Although advanced immune regulatory medications were approved for the treatment, it seems that avoidance of cow’s milk derivatives is the most effective therapeutic plan. In this study, we evaluated cow’s milk protein allergy in infants with a positive family history and its response to the treatment.

Material and Methods

We conducted a cohort study on infants with CMPA symptoms who visited the Najmiyeh Outpatients Clinic, Tehran, Iran, between February 2008 and November 2009. At first, we enrolled all the infants who were suspected to have CMPA; thereafter, CMPA was confirmed by applying an elimination challenge test on these infants. Other diagnoses were overruled and the CMPA treatment was started for one hundred infants with a confirmed diagnosis CMPA. We assessed the patients for their demographic and clinical characterizations. The clinical signs and symptoms, a family historyof atopy, the nutrition of the infants and their mothers and the weight of the infants were assessed. A family history of atopy such as asthma, drug allergies, allergic rhinitis, food allergies, atopic eczema, and urticaria was exactly evaluated. The patients were divided to three groups base on the type of their feeding. The first group was breastfed infants whose mothers were under a dietary regimen of avoidance of cow’s milk products. The second group was infants who were fed with formula based cow’s milk and soy; therefore, feeding with cow’s milk and a soy based formula was avoided. The third group was breastfed infants who were also fed with cow’s milk and the soy based formula or breastfed newborns whose mothers and they had used the complements. For the last group, the treatment plans of both the groups 1 and 2 were suggested. The patients were followed after a two week allergen avoidance regimen (AAR) and the efficacy of the regimen was assessed. According to the response of the infants to the AAR after the first two weeks, the cases were divided into three groups again. The first group was patients who showed a good response to the AAR and so we suggested that they leave the regimen gradually (within 2-3 months). The patients who showed an improper response following the AAR were divided into two groups. The second group consisted of the children who had not followed the regimen. The third group consisted of infants who did not show a suitable response to the treatment plan anyway. The regimen in these last groups was continued for two weeks and the patients were followed after two weeks again. This study was approved by the ethical committee of the Baqiyatallah University of Medical Sciences. The SPSS software, 16th edition and the c2 test were used for the analysis and a P value of < 0.05 was considered as significant.

Results

One hundred infants with a mean age of 4.23±2.02 months were enrolled in the study and 93 children completed the follow up (the loss to follow-up was 7%). 51 (54.8%) children who completed the survey were males and 42 (45.2%) were females. Bloody stool was the most common symptom which was seen in 74 (79%) infants, diarrhoea in was seen in 34 infants (36.6%), irritability was seen in 30 infants (32.3%), skin symptoms were seen in 20 infants (21.5%), vomiting was seen in 15 infants (16.1%), a gastro-oesophageal reflux (GER) was seen in 14 infants (15.1%), respiratory problems were seen in 6 infants (6.5%), anaemia was seen in 3 infants (3.2%), anal fissures were seen in 1 child (1.1%), diaper rash was seen in 5 infants (5.4%) and other symptoms were seen in 4 (4.34%) infants. A family history of atopy was identified in 77 (82.8%) children. 28 (30.1%) children had a positive family history through their fathers only, 27 (29%) had it through their mothers, and 13(14%) had it through both their fathers and mothers. 1 (1.2%) infant had a family history through other first-degree family members and 8 (8.6%) had it through second-degree family members. Allergic rhinitis was the most common type of family allergy which was in 50 infants (53.8%), followed by food allergy (41.9%), atopic eczema (20.4%), asthma and respiratory problems (10.8%) and adverse reactions to the medication (7.5%) [Table/Fig-1]. 60(71%) infants were fed by breast feeding solely, 9(9.7%) were fed by both breast feeding and formula, 4(4.3%) infants were fed only with formula, 3 (3.2%) infants were fed by breast feeding plus complement and finally, 2(2.2%) infants were fed with food only.

77 (82.8%) of the children had good weight gain, 10 (10.7%) had medial weight gain and 6 (6.5%) had weak weight gain. The treatment plan was as follows: avoidance of cow’s milk and its products for 76 (81.7%) mothers, avoidance of the complements which were based of cow’s milk for 2 (2.2%) mothers, avoidance of formula based cow’s milk or soya for 6 (6.5%) mothers, avoidance of dairy, cow’s milk and its products for 2 (2.2%) mothers and avoidance of cow’s milk for their infants; avoidance of cow’s milk, and dairy products for 7 (7.5%) mothers and avoidance of formula or soya for their infants. At their first visit after the treatment, 35 infants (37.6%) showed an excellent response and all their signs and symptoms were eliminated; therefore, the treatment plan was discarded within 2-3 months, gradually. 56 (60.2%) patients showed a relative response to the treatment, and 2 (2.2%) patients didn’t show any response to the treatment; therefore, the treatment plan was continued with more attention being paid, for 2 weeks again.

At the second visit, 53 (91.37% of the total) patients who had shown an improper response to the treatment showed a proper response to the treatment and 5 (8.63% of the total) of them didn’t show any response. Totally, 88 (94.6%) patients showed a suitable response to the treatment and 5 (5.37%) infants didn’t show any response to the avoidance [Table/Fig-2]. Among 53 infants with CMPA who were only fed by breast feeding and who had a positive family history of allergy, 49 (92.4%) showed a proper response to the treatment and 4 (7.6%) of them didn’tshow any response to the treatment. Also, among 13 infants with CMPA who were only fed by breast feeding and who didn’t have a family history of allergy, 12 (92.3%) showed a suitable response to the treatment. This difference was not statistically significant. (p >0.05) Out of 53 infants who were fed only by breast feeding and who had a family history of allergy, 49 (92.4%) showed good response to the treatment. Also, all the infants who were only fed by formula and who had a family history of allergy showed a good response to the treatment. This difference was not statistically significant (p>0.05). Among 34 infants with diarrhoea, 32 (94.1%) showed a good response to the treatment and 2 (5.9%) didn’t show a suitable response to the treatment. 69 (93.2%) of the 74 children with bloody stools showed a good response to the treatment. The response to the treatment was not affected by any of the underlying factors such as a family history of allergy, gender and age and clinical symptoms statistically. (p >0.05)

Discussion

In this study, a majority of the children (59%) were in the 3-6 months age group and this was similar to that in previous studies, which demonstrated the common age of CMPA [18-21]. Also, digestive symptoms were the most common symptoms in these patients (82.7%) that this was the same in other studies too [22-25]. Like in previous reports, other clinical symptoms and signs such as skin and respiratory symptoms were prevalent [18, 22-24]. In the present study, a family history of allergy was seen for 77 (92.7%) infants, although there was no correlation between the family history and the response to the AAR. This finding was similar to those of many other studies, whose findings reported a family history in up to 90% of the children who were studied [26-27]. More than one third of the infants in the first two weeks of the avoidance and more than half of the infants in the fourth week visit showed a proper response to the avoidance plan. Overall, 94.6% of the infants showed a good response to the treatment plan and 5.4% of them didn’t show any response to the treatment. These were referred for further evaluation. The complete response to the avoidance in this study was similar to that which was seen in other studies [28-29].

In previous reports, the prognosis of CMPA was suitable generally, with a remission rate of nearly 85 to 90% without a specific treatment. In particular, the gastrointestinal symptoms, as compared to the other symptoms, showed a pleasant prognosis that was comparable to our findings (30). Although the CMPA is a self limiting disorder, frequently and regressing along the time, its complications can affect the child’d growth. But this plan should be supervised closely because many of the parents don’t respect it. On the other hand, the elimination of cow’s milk from the dietary regimen may affect the growth of children and its avoidance must be done away with as soon as possible after establishing the therapeutic response (31). Also, alternative options such as hydrolyzed milk or camel’s milk may be useful for such children (32). In other studies, a family history of allergy which was reported as a risk factor was shown to affect the infants with CMPA, but a correlation between CMPA in infants and a family history of allergy wasn’t reported by them [32-35]. After surveying all the infants, we didn’t find any reasonable correlation between CMPA in the breastfed infants and a history of allergy in their parents. Also, a logical correlation between CMPA in the infants and the type of allergy in their families, such as allergic rhinitis and food allergies was lookedfor, but that wasn’t seen, too. Recently, advanced immune-based medication was used for the treatment of CMPA, especially for the refractory cases and further studies may make its role clear soon [36-37]. In conclusion, a family history of allergy in infants with CMPA must be considered. Almost, all the children, regardless of the underlying factor, could benefit from a regimen which was free of cow’s milk and its products. Therefore, the avoidance of these was recommended for all the children with CMPA, although the regimen should be respected and the response to the treatment should be followed closely.


Acknowledgement

We would like to acknowledge the childrens’ families who suitably cooperated for finalizing this survey.

References

1.
Temboury C, Polanco I. A comparative study of the infant morbidity in breast-fed and formula-fed infants in developed countries (Abstract). J Paediatr Gastroenterol Nutr 2000;31:671.
2.
Aberg N, Sundell J, Eriksson B, Hesselmar B, Aberg B. Prevalence of allergic diseases in school children in relation to the family history, upper respiratory infections, and the residential characteristics. Allergy, 1996;51:232.
3.
Dean T. Prevalence of allergic disorders in early infancy. Paediatr Allergy Immunol 1997;10:27.
4.
Tariq SM, Matthews SM, Hakim EA, et al. The prevalence of and the risk factors for atopy in early childhood: a whole population birth cohort study. J Allergy Clin Immunol 1998;101:587.
5.
Sampson HA. Immediate reactions to foods in infants and children In: Metcalfe DD, Sampson HA, Simon RA, eds. Food allergy: adverse reactions to foods and food additives. Boston: Blackwell Scientific Publications, 1997;169.
6.
Vandenplas Y, Brueton M, Dupont C, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child, 2007;92:902.
7.
Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Immunol, 2002;89(Suppl 1):33-7.
8.
Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. The clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Paediatr Allergy Immunol 2002, 13(Suppl 15):23-28.
9.
Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. The incidence, the pathogenic role of an early inadvertent exposure to the cow’s milk formula, and the characterization of the bovine milk protein in human milk. Acta Paediatr Scand 1988;77:663.
10.
Saarinen KM, Juntunen-Backman K, Ja¨rvenpaa AL, et al. Supplementary feeding in maternity hospitals and the risk of cow’s milk allergy: a prospective study of 6209 infants. J Allergy ClinImmunol, 1999;104:457.
11.
Herbert Brill, Approach to milk protein allergy in infants, Can Fam Physician, 2008;54:1258-64.
12.
Host A. Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Paediatr Allergy Immunol, 1994;5(5 Suppl):1-36.
13.
Heine RG, Elsayed S, Hosking CS, Hill DJ. Cow’s milk allergy in infancy. Curr Opin Allergy Clin Immunol, 2002;2(3):217-25.
14.
Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow’s milk allergy: is there a link? Paediatrics, 2002;110(5):972-84.
15.
Host A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to the clinical and immunological type of the hypersensitivity reaction. Allergy, 1990;45(8):587-96.
16.
Hill DJ, Hosking CS. Emerging disease profiles in infants and young children with food allergy. Paediatr Allergy Immunol, 1997;10(8):21.
17.
Saarinen KM, Pelkonen AS, Kela J Ma, Savilahti E. The clinical course and the prognosis of cow’s milk allergy are dependent on the milkspecific IgE status. J Allergy Clin Immunol, 2005;116(4):869.
18.
Brill H. An approach to milk protein allergy in infants. Can Fam Physician. 2008;54(9):1258.
19.
Baron ML. Assisting families in making appropriate feeding choices: cow’s milk protein allergy versus lactose intolerance. Paediatr Nurs. 2000;26(5):516-20.
20.
Vandenplas Y, Koletzko S, Isolauri E, Hill D, Orange AP, Brueton M, et al. Guidelines for the diagnosis and management of cow’s milk allergy in infants. Arch Dis Child. 2007;92(10):902.
21.
Hirose R, Yamada T, Hayashida Y. Massive bloody stools in two neonates which were caused by cow’s milk allergy. Paediatr Surq Int. 2006;22(11):935.
22.
Heine RG, Elsaved S, Hosking CS, Hill DJ. An approach to milk protein allergy in infants. Can Fam Physician, 2008; 54(9):1258.
23.
Ewing WM, Allen PJ. The diagnosis and management of cow milk protein intolerance in the primary care setting. Paediatr Nurs. 2005;31(6):486.
24.
Host A. Frequency of Cow’s milk allergy in childhood. Ann Allergy Asthma Immunol. 2002;89:33.
25.
Iacono G, DI Prima L, D’Amico D, Scalici C, Geraci C, Carroccio A. The “Red umbilicus”: a diagnostic sign of cow’s milk protein intolerance. J Paediatr Gastroenterol Nutr. 2006;42(5):531.
26.
Korol D, Kaczmarski M. A positive family history of allergy in children with hypersensitivity to cow’s milk. Med Sci Monit. 2001;7(5):966.
27.
Kubota A, Kawahara H, Okuyama H, Shimizu Y, Nakacho M, Ida S, et al. Cow’s milk protein allergy presenting with Hirchschsprung’s disease-mimicking symptoms. J Paediatr Surg. 2006; 41(12):2056.
28.
Lucarelli S, Di Nardo G, Lastrucci G, D’Alfonso Y, Marcheggiano A, Federici T, et al. Allergic proctocolitis which is refractory to a maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. BMC Gastroenterol. 2011 16;11:82.
29.
Leonard SA, Nowak-Wgrzyn A. Food protein-induced enterocolitis syndrome: an update on its natural history and the review of the management. Ann Allergy Asthma Immunol. 2011;107(2):95-101.
30.
Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol.2002;89(6 Suppl 1):33-7.
31.
Isolauri E, Sütas Y, Salo MK, Isosomppi R, Kaila M. Elimination diet in cow’s milk allergy: risk for impaired growth in young children. J Paediatr. 1998 Jun;132(6):1004-9.
32.
Ehlayel MS, Hazeima KA, Al-Mesaifri F, Bener A. Camel’s milk: an alternative for cow’s milk for children with CMPA. Allergy Asthma Proc. 2011 May-Jun;32(3):255-8.
33.
Saarinen KM, Pelkonen AS, Makela MJ, Savilahti E. The clinical course and the prognosis of cow’s milk allergy are dependent on the milkspecific IgE status. J Allergy Clin Immunol. 2005;116(4):869.
34.
Ram FS, Ducharme FM, Scarett J. Cow’s milk protein avoidance and the development of childhood wheeze in children with a family history of atopy. Cochrane Database Syst Rev. 2007; 18(2):3795.
35.
Arshad SH. Food allergen avoidance in the primary prevention of food allergy. Allergy. 2001;56(67):113.
36.
Skripak JM, Matsui EC, Mudd K, Wood R.A. The natural history of IgE-mediated cow’s milk allergy. J Allergy ClinImmunol. 2007; 120(5):1172.
37.
Mever R. New guideline for managing cow’s milk allergy in infants. J Fam Health. 2008; 18(1):27.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com