Table 1.
Mechanism | IgE-mediated CMA | Non-IgE, cell mediated or mixed pathophysiology CMA |
---|---|---|
Symptoms | Skin: urticaria, angioedema; GI: throat swelling, crampy abdominal pain, immediate emesis, diarrhea; Respiratory: rhinorrhea, sneezing, laryngospasm, cough, bronchspasm; CV: tachycardia, low blood pressure; Generalized: anaphylaxis |
Chronic: Skin: eczematous skin rash; GI: nausea, emesis, reflux, abdominal pain, diarrhea, malabsorption, rectal bleeding Generalized: poor weight gain, failure to thrive, stunting Acute-FPIES: GI: projectile emesis, abdominal pain, diarrhea; CV: tachycardia, hypotension, hypovolemic/distributive shock; Generalized: pallor, lethargy |
Onset of symptoms following food ingestion | Within minutes to 2 h | Generally within hours to days; exception acute FPIES-onset of emesis within 2–4 h |
Diagnosis | Detection of food-sIgE by skin prick test and serologic tests, oral food challenge | Recognition of symptoms, response to diagnostic elimination diet (2–4 weeks); FPIES-meeting the diagnostic criteria |
Management -acute symptoms | Antihistamines, epinephrine, inhaled bronchodilator, oxygen, intravenous fluids | FPIES: rehydration (oral or intravenous), ondansetron (oral or parenteral), single dose of a steroid for severe symptoms |
Management-dietary | Dietary food avoidance, majority tolerate cow's milk in the form of baked foods | Dietary food avoidance; a subset of patients might tolerate cow's milk in the form of baked foods |
Natural history | Favorable, generally outgrown before school age; children reacting to baked milk or with peak cow's milk-sIgE >50 kUa/L tend to have a more prolonged course | Favorable, usually outgrown by age 1–3 years |