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Review
. 2018 Nov 9;10(11):1716.
doi: 10.3390/nu10111716.

Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?

Licia Pensabene  1 , Silvia Salvatore  2 , Enza D'Auria  3 , Francesca Parisi  4 , Daniela Concolino  5 , Osvaldo Borrelli  6 , Nikhil Thapar  7 , Annamaria Staiano  8 , Yvan Vandenplas  9 , Miguel Saps  10
Affiliations
Review

Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?

Licia Pensabene et al. Nutrients. .

Abstract

The role and prevalence of cow's milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.

Keywords: CMA; FGIDs; abdominal pain; allergy; gastrointestinal; hypersensitivity.

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Conflict of interest statement

The authors declare no conflict of interest. S.S. has participated as consultant and/or speaker for Deca, IMS-Health, Danone, Nestlé, and Menarini; N.T. has participated as an advisory board member and/or speaker for Nutricia and Danone. A.S. has participated as a clinical investigator, advisory board member, consultant, and/or speaker for D.M.G, Valeas, Angelini, Miltè, Danone, Nestlé, Sucampo, and Menarini. Y.V. has participated as a clinical investigator, advisory board member, consultant, and/or speaker for Abbott Nutrition, Aspen, Biocodex, Danone, Nestle Health Science, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition, Merck, Phacobel, Rontis, United Pharmaceuticals, Wyeth, and Yakult M.S. has served as a Scientific Consultant for Forest, Quintiles, Ardelyx, IM HealthScience, QOL Medical, and Sucampo. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
The pathophysiology of functional gastrointestinal disorders (FGIDs) is multifactorial.
See this image and copyright information in PMC

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