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Cow's milk associated rectal bleeding: a population based prospective study.
Pediatr Allergy Immunol. 2012 Dec; 23(8):766-70.PA

Abstract

BACKGROUND

Isolated rectal bleeding in infants is often attributed to the consumption of cow's milk. However, the prevalence of this condition has not been described, and its preferred diagnostic methods and management are controversial.

METHODS

In a prospective population-based study following 13,019 children from birth, 21 infants with isolated rectal bleeding attributed to cow's milk protein consumption were identified. Following evaluation, parents were encouraged to resume cow's milk protein and infants were followed for reappearance of symptoms and thereafter for 6 yr. In addition, infants with rectal bleeding were compared to a control group of healthy infants.

RESULTS

The prevalence of isolated rectal bleeding attributed to cow's milk consumption was 0.16%. All infants were asymptomatic within days of dietary modifications. Eleven of the 14 infants (78.5%) whose parents reintroduced cow's milk protein to their diet following our evaluation tolerated it with no adverse effects. Those 11 infants were significantly younger at initial consumption of cow's milk protein (6.7 ± 1.6 months) compared to those who continued elimination diet (17.7 ± 9.2 months), (p = 0.002) while their 1-yr hemoglobin levels were comparable (p = 0.98). No risk factors for rectal bleeding were identified.

CONCLUSIONS

The prevalence of isolated rectal bleeding attributed to cow' milk is low. The condition is generally benign and resolves quickly with elimination diet. Reintroduction of cow's milk following resolution of symptoms is often well tolerated and is recommended for confirming the diagnosis and avoiding prolonged unnecessary elimination diets.

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Authors+Show Affiliations

Elizur A
Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel. elizura@gmail.com
Cohen M
No affiliation info available
Goldberg MR
No affiliation info available
Rajuan N
No affiliation info available
Cohen A
No affiliation info available
Leshno M
No affiliation info available
Katz Y
No affiliation info available

MeSH

AnimalsBreast FeedingCattleFemaleGastrointestinal HemorrhageHumansInfantMaleMilkMilk HypersensitivityProspective StudiesRectum

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23050491

Citation

Elizur, Arnon, et al. "Cow's Milk Associated Rectal Bleeding: a Population Based Prospective Study." Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, vol. 23, no. 8, 2012, pp. 766-70.
Elizur A, Cohen M, Goldberg MR, et al. Cow's milk associated rectal bleeding: a population based prospective study. Pediatr Allergy Immunol. 2012;23(8):766-70.
Elizur, A., Cohen, M., Goldberg, M. R., Rajuan, N., Cohen, A., Leshno, M., & Katz, Y. (2012). Cow's milk associated rectal bleeding: a population based prospective study. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, 23(8), 766-70. https://doi.org/10.1111/pai.12009
Elizur A, et al. Cow's Milk Associated Rectal Bleeding: a Population Based Prospective Study. Pediatr Allergy Immunol. 2012;23(8):766-70. PubMed PMID: 23050491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cow's milk associated rectal bleeding: a population based prospective study. AU - Elizur,Arnon, AU - Cohen,Michal, AU - Goldberg,Michael R, AU - Rajuan,Nelly, AU - Cohen,Adi, AU - Leshno,Moshe, AU - Katz,Yitzhak, Y1 - 2012/10/11/ PY - 2012/08/30/accepted PY - 2012/10/12/entrez PY - 2012/10/12/pubmed PY - 2013/6/5/medline SP - 766 EP - 70 JF - Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology JO - Pediatr Allergy Immunol VL - 23 IS - 8 N2 - BACKGROUND: Isolated rectal bleeding in infants is often attributed to the consumption of cow's milk. However, the prevalence of this condition has not been described, and its preferred diagnostic methods and management are controversial. METHODS: In a prospective population-based study following 13,019 children from birth, 21 infants with isolated rectal bleeding attributed to cow's milk protein consumption were identified. Following evaluation, parents were encouraged to resume cow's milk protein and infants were followed for reappearance of symptoms and thereafter for 6 yr. In addition, infants with rectal bleeding were compared to a control group of healthy infants. RESULTS: The prevalence of isolated rectal bleeding attributed to cow's milk consumption was 0.16%. All infants were asymptomatic within days of dietary modifications. Eleven of the 14 infants (78.5%) whose parents reintroduced cow's milk protein to their diet following our evaluation tolerated it with no adverse effects. Those 11 infants were significantly younger at initial consumption of cow's milk protein (6.7 ± 1.6 months) compared to those who continued elimination diet (17.7 ± 9.2 months), (p = 0.002) while their 1-yr hemoglobin levels were comparable (p = 0.98). No risk factors for rectal bleeding were identified. CONCLUSIONS: The prevalence of isolated rectal bleeding attributed to cow' milk is low. The condition is generally benign and resolves quickly with elimination diet. Reintroduction of cow's milk following resolution of symptoms is often well tolerated and is recommended for confirming the diagnosis and avoiding prolonged unnecessary elimination diets. SN - 1399-3038 UR - https://www.unboundmedicine.com/medline/citation/23050491/Cow's_milk_associated_rectal_bleeding:_a_population_based_prospective_study_ L2 - https://doi.org/10.1111/pai.12009 DB - PRIME DP - Unbound Medicine ER -