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Nutrients 2018, 10(11), 1716;

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

Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
Department of Medicine and Surgery, Section of Pediatrics, University of Insubria, 21100 Varese, Italy
Department of Pediatrics, Vittore Buzzi Children’s Hospital-University of Milan, 20154 Milan, Italy
Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy
KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Holtz Children’s Hospital, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
These authors contributed equally to this work.
Author to whom correspondence should be addressed.
Received: 16 October 2018 / Revised: 4 November 2018 / Accepted: 6 November 2018 / Published: 9 November 2018
(This article belongs to the Special Issue Nutrition and Functional Abdominal Pain)
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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. View Full-Text
Keywords: CMA; allergy; hypersensitivity; FGIDs; gastrointestinal; abdominal pain CMA; allergy; hypersensitivity; FGIDs; gastrointestinal; abdominal pain

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Pensabene, L.; Salvatore, S.; D'Auria, E.; Parisi, F.; Concolino, D.; Borrelli, O.; Thapar, N.; Staiano, A.; Vandenplas, Y.; Saps, M. Cow’s Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Nutrients 2018, 10, 1716.

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