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Review

Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

1
Department of Medicine and Surgery, Pediatric Unit, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
2
Department of Biomedical Sciences and Human Oncology-Neonatology and NICU Section, “Aldo Moro” University of Bari, 70124 Bari, Italy
3
Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
4
Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
5
Kidz Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
*
Author to whom correspondence should be addressed.
Academic Editor: Sara Manti
Nutrients 2021, 13(2), 297; https://doi.org/10.3390/nu13020297
Received: 24 December 2020 / Revised: 16 January 2021 / Accepted: 18 January 2021 / Published: 21 January 2021
(This article belongs to the Special Issue Food Allergies in Modern Life)
Cow’s milk allergy (CMA) and gastro-esophageal reflux disease (GERD) may manifest with similar symptoms in infants making the diagnosis challenging. While immediate reaction to cow’s milk protein indicate CMA, regurgitation, vomiting, crying, fussiness, poor appetite, sleep disturbances have been reported in both CMA and GERD and in other conditions such as functional gastrointestinal disorders, eosinophilic esophagitis, anatomic abnormalities, metabolic and neurological diseases. Gastrointestinal manifestations of CMA are often non-IgE mediated and clinical response to cow’s milk free diet is not a proof of immune system involvement. Neither for non-IgE CMA nor for GERD there is a specific symptom or diagnostic test. Oral food challenge, esophageal pH impedance and endoscopy are recommended investigations for a correct clinical classification but they are not always feasible in all infants. As a consequence of the diagnostic difficulty, both over- and under- diagnosis of CMA or GERD may occur. Quite frequently acid inhibitors are empirically started. The aim of this review is to critically update the current knowledge of both conditions during infancy. A practical stepwise approach is proposed to help health care providers to manage infants presenting with persistent regurgitation, vomiting, crying or distress and to solve the clinical dilemma between GERD or CMA. View Full-Text
Keywords: reflux; GER; GERD; cow’s milk allergy; CMA; eosinophilic esophagitis; infants; hydrolyzed formula; alginate; thickened formula reflux; GER; GERD; cow’s milk allergy; CMA; eosinophilic esophagitis; infants; hydrolyzed formula; alginate; thickened formula
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MDPI and ACS Style

Salvatore, S.; Agosti, M.; Baldassarre, M.E.; D’Auria, E.; Pensabene, L.; Nosetti, L.; Vandenplas, Y. Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants? Nutrients 2021, 13, 297. https://doi.org/10.3390/nu13020297

AMA Style

Salvatore S, Agosti M, Baldassarre ME, D’Auria E, Pensabene L, Nosetti L, Vandenplas Y. Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants? Nutrients. 2021; 13(2):297. https://doi.org/10.3390/nu13020297

Chicago/Turabian Style

Salvatore, Silvia, Massimo Agosti, Maria E. Baldassarre, Enza D’Auria, Licia Pensabene, Luana Nosetti, and Yvan Vandenplas. 2021. "Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?" Nutrients 13, no. 2: 297. https://doi.org/10.3390/nu13020297

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