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Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?
Licia Pensabene1, Silvia Salvatore2, Enza D'Auria3
1Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy. pensabene@unicz.it.
Insights
Cow's milk protein allergy (CMA) may contribute to functional abdominal pain disorders (FAPDs) in children, though evidence is limited. Diagnosis is challenging, but elimination diets and oral food challenges can help identify CMA in FAPDs.
Area of Science:
- Pediatric Gastroenterology
- Allergology
- Immunology
Background:
- Cow's milk protein allergy (CMA) and functional gastrointestinal disorders (FGIDs) are common in children.
- The precise relationship between CMA and functional abdominal pain disorders (FAPDs) is not well-established.
Purpose of the Study:
- To review and update current knowledge on the association between CMA and FAPDs in pediatric populations.
- To explore potential pathogenetic mechanisms linking CMA and FAPDs.
Main Methods:
- A comprehensive literature search was conducted using Cochrane Database and PubMed.
- Keywords included terms for cow's milk protein allergy and functional gastrointestinal disorders.
Main Results:
- CMA is implicated as a potential predisposing or coexisting factor in various pediatric FGIDs, including FAPDs.
- Complex pathogenetic mechanisms, such as dysmotility and hypersensitivity, may link CMA and FAPDs.
- Limited data currently support a direct causal role of food allergies in FAPDs pathogenesis.
Conclusions:
- CMA might predispose children to early-life inflammation and visceral hypersensitivity, potentially leading to FAPDs.
- Diagnosing CMA and FAPDs is difficult due to overlapping, nonspecific symptoms and limitations in allergy testing for non-IgE mediated cases.
- An elimination diet followed by an oral food challenge is recommended for diagnosing non-IgE mediated CMA in children with FAPDs. Short-term elimination diets should be considered for FAPDs management to assess symptom response.
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.