Abstract
Food allergies (FAs) are an increasing problem in Western countries, affecting up to 10% of young children. FAs are frequently associated with gastrointestinal manifestations. The role of FAs as a potential causative factor for infantile colic (IC) is still controversial. We report the most recent evidence on the pathogenesis, clinical and diagnostic aspects of FA-induced infantile colic (IC) and suggest a stepwise diagnostic approach. We selected articles on clinical and immunologic features, pathogenesis and management of FAs and IC from of 1981 to 2015. Original and review articles were identified through selective searches performed on PubMed, using the following terms: colic, infantile colic, food allergy and infantile colic, infantile colic treatment. The possible relationship between FAs and IC derives from the presence of dysmotility with visceral hypersensitivity and dysbiosis, demonstrated in both conditions, and the clinical response to dietary interventions. Unfortunately, the design of the studies, poor characterization of atopy and different dietary approaches limit the understanding of the importance of FAs in subjects with IC. The role of FAs in IC subjects without other symptoms of atopy remains controversial. However, where there is a suspicion of FAs, a short trial with an extensively hydrolyzed cow’s proteins formula or, if breast fed, with maternal elimination diet may be considered a reasonable option.
Highlights
Food allergies (FAs) are an increasing problem in Western countries
The most recent available epidemiological data on childhood FAs suggest that the number of true cases of FAs-induced infantile colic (IC) should be lower than estimated by physicians
Poor characterization of atopy in enrolled subjects and different dietary approaches limit our understanding of the impact of FAs in IC
Summary
Food allergies (FAs) are an increasing problem in Western countries. The overall pooled point prevalence of FAs reported by parents in children aged 0–17 years is 6.86% (95% CI 6.58–7.15) [1]. It has been proposed that FAs can occur through cutaneous and/or airway sensitization [5,6] Infantile colic (IC), defined according to Rome III criteria as episodes of irritability, fussing or crying that begin and end for no apparent reason and last ≥3h per day, ≥3days per week, for ≥1week [7], is a common condition in the first three months of life, affecting up to about 25% of infants [8] Even though it mostly resolves by 3–4 months of age, it is often a frustrating problem for parents. We propose a stepwise diagnostic approach in order to limit unnecessary dietary procedures, thereby resulting in a better management of this condition
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