The controversial role of food allergy in infantile colic: evidence and clinical management

Abstract

Food allergies (FAs) are an increasing problem in Western countries, affecting up to 10% of young children. FAs are frequently associated with gastrointestinal manifestations. The role of FAs as a potential causative factor for infantile colic (IC) is still controversial. We report the most recent evidence on the pathogenesis, clinical and diagnostic aspects of FA-induced infantile colic (IC) and suggest a stepwise diagnostic approach. We selected articles on clinical and immunologic features, pathogenesis and management of FAs and IC from of 1981 to 2015. Original and review articles were identified through selective searches performed on PubMed, using the following terms: colic, infantile colic, food allergy and infantile colic, infantile colic treatment. The possible relationship between FAs and IC derives from the presence of dysmotility with visceral hypersensitivity and dysbiosis, demonstrated in both conditions, and the clinical response to dietary interventions. Unfortunately, the design of the studies, poor characterization of atopy and different dietary approaches limit the understanding of the importance of FAs in subjects with IC. The role of FAs in IC subjects without other symptoms of atopy remains controversial. However, where there is a suspicion of FAs, a short trial with an extensively hydrolyzed cow's proteins formula or, if breast fed, with maternal elimination diet may be considered a reasonable option.

Figure 1

Gut-brain axis interactions in food allergy-induced infantile colic.

Figure 2

The diagnostic approach for suspected food allergy-induced infantile colic in formula-fed babies. *, If the child is breastfed it could be consider a monitored hypoallergenic maternal diet avoiding eggs, peanuts, tree nuts, wheat, soy, fish, cow’s milk protein containing foods; EHF: extensively hydrolyzed formula; FA: food allergy; IgE: immunoglobulin E.