Allergy to extensively hydrolyzed formula in an infant with cow’s milk allergy and transient hypogammaglobulinemia

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disorder with an increased prevalence among infants, being the first manifestation of the „allergic march”. Food allergies are the main triggers for this pathology and it is commonly known that the younger the infant, the higher the risk of developing AD. Treatment of AD as a consequence of allergy to cow’s milk protein (CMPA) consists in administrating a therapeutic formula such as an extensively hydrolyzed formula (eHF), or an Amino Acid Formula (AAF), hygienic measures, and anti-inflammatory treatment. We present the case of a 2 months old infant, artificially fed since birth, submitted to the Second Clinic of Pediatrics, “Sf. Maria” Emergency Hospital for Children Iasi, for a moderate form of AD due CMPA, associated with transient hypogammaglobulinemia (TH). The diagnosis was established using Hanifin and Rajka criteria, the dosage of specific serum IgE (sIgE) for cow’s milk proteins (CMP), and the positive response to diet replacement. The severe clinical manifestations were caused by the cutaneous infection with Staphylococcus aureus, and exacerbated by immunodeficiency. Under antibiotic treatment and the introduction of eHF in the infant’s diet, we record a positive evolution. The infant is readmitted in the Pediatrics Clinic 72 hours after discharge, with moderate dehydration associated with diarrheic stools, requiring the replacement of eHF with an AAF. Although rarely encountered, allergies to eHF are reported in 10% of patients with AD, and usually manifest with gastrointestinal symptoms. AAF is an efficient therapeutic replacement for this category of infants.