Wednesday, December 13, 2006
Cow’s milk protein intolerance or dairy allergy and the red belly button sign.
Redness of the belly button (umbilicus) is a diagnostic sign of cow’s milk protein intolerance (CMPI). This unusual but very specific physical sign was present in almost 10% of Italian children confirmed with CMPI. The red umbilicus sign was seen in children with gastrointestinal (GI) symptoms as well as those with respiratory and dermatological symptoms of food intolerance. The redness went away on an elimination diet (ED) and reappeared on food challenge. This was not seen in children without food intolerance.
Prior to diagnosis and ED trial, the red belly button appeared after or at the same time as milk allergy symptoms in 90% in whom it was observed. The redness disappeared before the end of the second week of the ED, usually by five days, but reappeared within 24 hours when cow’s milk protein was re-introduced. On challenge the red belly button sign often reappeared before the main symptom(s) of CMPI.
Though uncommon, parents and doctors should remember this highly specific but odd sign of cow's milk and other food protein intolerance. If your child has a red belly button, think food allergy or intolerance. If tests for food allergy or intolerance are negative or non-diagnostic, I recommend an elimination diet trial followed by re-challenge. A food symptom diet diary should be recorded before after the ED.
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Reference: Iacono G., et. al. The “Red Umbilicus”: A Diagnostic Sign of Cow’s Milk Protein Intolerance. Journal of Pediatric Gastroenterology and Nutrition 2006:42(5); 532-534.
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