Cow’s Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Fecha: Lunes 3 de diciembre de 2018

Cow’s Milk Protein Allergy in Infancy: A Risk

Factor for Functional Gastrointestinal

Disorders in Children?

Authors
Licia Pensabene 1,*,†, Silvia Salvatore 2,†, Enza D’Auria 3,†, Francesca Parisi 1, Daniela Concolino 1, Osvaldo Borrelli 4, Nikhil Thapar 4, Annamaria Staiano 5, Yvan Vandenplas 6 and Miguel Saps 7

1 Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro 88100 Catanzaro, Italy; parisifrancesca01983@gmail.com (F.P.); dconcolino@unicz.it (D.C.)
2 Department of Medicine and Surgery, Section of Pediatrics, University of Insubria,21100 Varese, Italy; silvias.varese@gmail.com
3 Department of Pediatrics, Vittore Buzzi Children’s Hospital-University of Milan, 20154 Milan, Italy; enza.dauria@unimi.it
4 Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; Osvaldo.Borrelli@gosh.nhs.uk (O.B.); Nikhil.Thapar@gosh.nhs.uk (N.T.)
5 Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy; staiano@unina.it
6 KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; Yvan.Vandenplas@uzbrussel.be
7 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Holtz Children’s Hospital,
University of Miami, Miller School of Medicine, Miami, FL 33136, USA; msaps@med.miami.edu
* Correspondence: pensabene@unicz.it; Fax:+39-961-883489
† These authors contributed equally to this work.

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.

DOI: https://doi.org/10.3390/nu10111716