Current status of digestive intolerance to food protein

Digestive intolerance to food proteins may occur in childhood as a result of a wide range of etiologic and pathophysiologic mechanisms. Cow milk protein intolerance is the most common form of food intolerance in children. Food allergy and food intolerance may be confused because both produce similar symptoms, especially in young children with clinical manifestations of food allergy localized to the gastrointestinal tract. On the other hand, food-sensitive enteropathy may be defined as the clinical food-related syndromes associated with an abnormal small intestinal mucosa. Although several foods have been reported to damage the small intestinal mucosa in infancy (soy, rice, fish, chicken meat, egg), cow milk-sensitive enteropathy is the most common cause. Whatever the mechanisms, digestive intolerance to food proteins with or without enteropathy is primarily a temporary condition of infancy, in contrast to most forms of food allergy. In children with these disorders, symptoms usually resolve by 1 to 3 years of age. The variation in prevalence rates of this disorder in different countries can be explained by different diagnostic criteria. The classic food-sensitive enteropathy syndromes with chronic diarrhea and failure to thrive in infancy have become rarer in some European countries, including Spain. Some risk factors for the development of these conditions appear to be early exposure to cow milk feedings, acute infectious diarrhea, and malnutrition. Breast-feeding appears to be at least partially protective.