Infantile Colic: When to Suspect Cow's Milk Allergy.

Area of Science:

• Pediatrics
• Allergology
• Gastroenterology

Background:

• Infant colic (IC) affects 20-30% of infants globally, characterized by excessive crying and unsettled behavior in the first three months.
• The underlying causes of infant colic remain poorly understood, necessitating further investigation into potential contributing factors.
• Cow's milk allergy (CMA) is a potential, though not fully established, cause of infant colic.

Purpose of the Study:

• To critically review existing literature on the association between infant colic and cow's milk allergy.
• To evaluate the diagnostic approach for identifying CMA in infants presenting with colic.

Main Methods:

• A comprehensive literature search was conducted using MeSH terms for cow's milk allergy, food allergy, colic, and crying.
• The search was limited to English-language articles from inception up to June 15, 2025, identifying 135 relevant publications.
• Eighteen clinical trials focusing on the impact of cow's milk elimination diets on infant colic were specifically analyzed.

Main Results:

• The role of CMA in infant colic, especially without other allergic signs, is currently uncertain.
• CMA should be considered in cases of persistent infant colic unresponsive to standard treatments, particularly if other allergic manifestations are present.
• A diagnostic elimination diet, involving maternal cow's milk exclusion or specialized formulas, followed by reintroduction, is crucial for diagnosing CMA.

Conclusions:

• Current evidence linking CMA to infant colic is limited, highlighting the need for more research.
• Future research should focus on large, well-designed clinical trials to investigate CMA in both breastfed and formula-fed colicky infants.
• Diagnostic elimination diets are essential for confirming CMA in infants with persistent colic and suspected allergic reactions.