Cows ' milk-sensitive enteropathy

SUMMARY Serial small intestinal biopsies related to withdrawal and challenge with cows ' milk are described in 5 infants with cows ' milk protein intolerance. On the basis of these serial observations the existence of a cows ' milk-sensitive enteropathy in infancy is clearly established. The cows ' milk-sensitive mucosal lesion varied in its severity ranging from a partly flat mucosa to a mild degree of partial villous atrophy. Intraepithelial lymphocyte counts rose after a positive milk challenge, but on only one occasion to a level outside the normal range. The technique of serial biopsies related to dietary milk enables a firm diagnosis of cows ' milk intolerance to be made upon the basis of a single milk challenge. Clinically this appears to be a temporary condition which disappears by the age of 2 years. Small intestinal mucosal abnormalities in children with a malabsorption syndrome induced by cows' milk were first reported by Lamy et al. in 1963, and have been widely confirmed subsequently (Kuitunen et al., 1965; Shiner et al., 1975a; Fontaine and Navarro, 1975; Walker-Smith, 1975). Kuitunen et al. (1973) described a milk provocation test in children who had previously responded to a cows' milk-free diet. They observed morphological changes in the small intestinal mucosa when there was a clinical relapse on milk challenge. It has been suggested that routine histological examination of small intestinal biopsies before and after a cows' milk challenge is the most helpful way to diagnose cows ' milk allergy (Walker-Smith, 1975, 1976; Shiner et al., 1975b). Yet sceptics continue to deny the very existence of cows ' milk protein intolerance, and in Britain until recently, this entity has been an uncommon clinical diagnosis