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

Licia Pensabene,Annamaria Staiano,Nikhil Thapar,Miguel Saps,Yvan Vandenplas,Osvaldo Borrelli,Francesca Parisi,Enza D'Auria,Silvia Salvatore,Daniela Concolino

doi:10.3390/nu10111716

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.

Highlights

Cow’s milk (CM) allergy (CMA) is one of the most common food allergies in infants and young children with a prevalence of 2–5% [1,2,3,4,5,6]
IgE-mediated cow’s milk protein allergy (CMA) often persists into school age and is a risk factor for other atopic diseases [2]. We focus on both CMA-related GI symptoms and CMA as a predisposing condition to subsequent functional abdominal pain disorders (FAPDs), defined as functional gastrointestinal disorders (FGIDs) with abdominal pain as a driving symptom
CMA may be associated with FGIDs or may manifest symptoms mimicking FGIDs

Summary

Introduction

Cow’s milk (CM) allergy (CMA) is one of the most common food allergies in infants and young children with a prevalence of 2–5% [1,2,3,4,5,6]. Food allergy is defined as an adverse health effect related to the exposure to a given food, arising from specific immunoglobulin (Ig)E mediated, non-IgE mediated (cellular mediated), or mixed [7,8] immune responses. The major milk allergens are whey proteins (ß-lactoglobulin being the most abundant) and caseins [9]. Previous studies over the past few decades have suggested that casein may be the major cow’s milk protein toward which reactions might occur. Patients with persistent CMA showed IgE reactivity towards casein epitopes, such as α s1 and β casein, compared to those whose developed clinical tolerance [10]

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