Cow’s milk protein elimination in autistic children: language, cognitive and behavioral outcome

Background: Behavioral modification and structured education are necessary in autism but rather insufficient. Various dietary restrictions have been suggested as important prerequisites to benefit from other interventions in this disorder. Objective: This study was designed to highlight the degree of benefit in various aspects of development of autistic children upon elimination of cow's milk protein (CMP) from their diet and assess the level of specific IgE for CMP in their sera. Methods: The current study was conducted on 22 autistic children who were compared to 30 age and sex matched healthy children. Enrolled autistic children were randomly assigned to one of two groups. The parents of first group were instructed to eliminate cow milk (CM) from the diet of their children throughout the study period while patients of the second group were allowed to eat without restrictions. Each enrolled child was subjected to complete dietetic history taking, clinical examination and measurement of IgE for CM antigen in their sera by enzyme immunoassay. Autistic patients underwent a Childhood Autism Rating Scale (CARS) test. The patients were also subjected to language and intelligent quotient (IQ) testing, social and mental age assessment and child psychiatric evaluation. The autistic children received an interventional program for six months and were then re-evaluated using the previous clinical parameters. Results: The first group achieved significantly lower CARS test results (p < 0.01), significantly higher language age (p < 0.05) and significantly higher rate of change of CARS, language, social age, mental age and IQ (p < 0.001, <0.05, <0.05, <0.01 and <0.05 respectively) compared to the second group after 6 months of follow up. There was also a significantly higher mean specific IgE level to CMP in the autistic patients as compared to the controls. Additionally, 45.5% of patients who were on CM elimination diet went one CARS category down compared to only 36.4% of the second group. Conclusion: We report improvement in language, cognition and behavioral capabilities upon CM elimination in a group of autistic children. The higher CM specific IgE in these children may suggest that such adverse reaction to CM may have an allergic basis. Wider scale studies are needed to justify this adjuvant therapeutic option in autistic children hoping for better achievement from the current interventional programs. Keywords: Allergy – Autism – CARS – Cow milk – IgE – IQ Egypt J Pediatr Allergy Immunol 2006; 4(1): 15-21