Hematuria due to Cow Milk Allergy: a case report

Document Type : Case Report


1 Assistant Professor, Department of Pediatrics, Mohammad kermanshahi Hospital & Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Associate Professor, Department of Pediatrics, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: Cow milk allergy is one of the most common food allergies in young children causing a wide range of clinical syndromes due to immunologic responses to cow milk proteins. In this report we introduce an infant with dietary protein proctitis due to a cow’s milk referred with hematuria and bloody stool.
Case Presentation: Our case was a 10- month old male infant with hematuria and bloody stool following consumption of yogurt. The infant had prior history of blood in stool at 20th day and 2nd month of life while exclusively breastfed. The episodes of bloody stool had been resolved at the time with elimination of cow milk dairy products form the mother’s diet. All physical examinations and laboratory tests were normal and with stopping Bovine products, the symptoms were disappeared.
Conclusion: Allergy should be considered as a probable diagnosis in children with otherwise unexplained hematuria.


Hertzber LA , Finkel Y, Sandstedt B, Karpe B. Protocolitis in exclusively breast-fed infants: European Journal of Pediatrics ,June 1996, Volume 155, Issue 6, pp 464-467
Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, et al. NIAID-Sponsored Expert Panel,J Allergy Clin Immunol. 2010;126
H. A. Sampson and J. A. Anderson, “Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children,” Journal of Pediatric Gastroenterology and Nutrition, vol. 30, no. 1, pp. S87–S94, 2000
Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein- induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111(4 Pt 1):82
Chen WL, Hwang MT, Liau CY, Ho JC, Hong KC, Mao SJ. Beta-lactoglobulin is a thermal marker in processed milk as studied by electrophoresis and circular dichroic spectra. J Dairy Sci 2005; 88:1618.
Ehn BM, Ekstrand B, Bengtsson U, Ahlstedt S. Modification of IgE binding during heat processing of the cow's milk allergen beta-lactoglobulin. J Agric Food Chem 2004; 52:1398.
Nowak-Wegrzyn A, Bloom KA, Sicherer SH, Noone, S., Moshier, E.L., Godbold,J et al. Tolerance to extensively heated milk in children with cow's milk allergy. J Allergy Clin Immunol 2008; 122:342.
Høst A. Cow's milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol 1994; 5:1.
Järvinen KM, Chatchatee P. Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis. Curr Opin Allergy Clin Immunol 2009; 9:251.
Fiocchi A, Schünemann HJ, Brozek J, Beyer K, Troncone R, Martelli A, Terracciano L, et al. Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report. J Allergy Clin Immunol 2010; 126:1119.
Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Use of multiple doses of epinephrine in food-induced anaphylaxis in children. J Allergy Clin Immunol 2008; 122:133.
Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Use of multiple doses of epinephrine in food-induced anaphylaxis in children. J Allergy Clin Immunol 2008; 122:133.
Uguz A, Lack G, Pumphrey R, Ewan P, Warner J, Dick J, et al. Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaign. Clin Exp Allergy 2005; 35:746.
Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999; 104:S114.
Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999; 29:91.
Ingelfinger JR, Davis AE, Grupe WE. Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics 1977; 59:557.
Patel HP, Bissler JJ. Hematuria in children. Pediatr Clin North Am 2001; 48:1519. 18. D'Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol 2004; 24:179
Emancipator SN. IgA nephropathy: morphologic expression and pathogenesis. Am J Kidney Dis 1994; 23:451.
Galla JH. IgA nephropathy. Kidney Int 1995; 47:377.
S Gulati, C B Langman, D Pena. Hematuria. http://emedicine.medscape.com
D Manzini, AC Jeevarathnum, A van Rooyen. pulmonary haemosiderosis Current Allergy & Clinical Immunology March 2015 Vol 28, No 1
Nuesslein TG, Teig N, Rieger CHL. Pulmonary haemosiderosis infants and children. Paed Resp Reviews 2006;7:45-48.
Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL. Mild-induced pulmonary disease in infants (Heiner syndrome). Ped Allergy Immunol 2005;16:545-552
P. Ammann and E. Rossi .Arch Dis Child 1966 41: 539-540
Lelong M,PigronB, .Arch Fr Pediatric 1989 jun-july 46(6)447-8
GrahmDM,McMoriss MS,FlynnJT. Clin Nephrol 2002 Nov:58(5);389-92
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol 2010; 21 Suppl 21:1.
NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy ClinImmunol 2010; 126:S1