Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

Calvani, Mauro; Anania, Caterina; Cuomo, Barbara; D’Auria, Enza; Decimo, Fabio; Indirli, Giovanni Cosimo; Marseglia, Gian Luigi; Mastrorilli, Violetta; Sartorio, Marco Ugo Andrea; Santoro, Angelica; Veronelli, Elisabetta

doi:10.3390/nu13010226

Cited by 51 publications

(76 citation statements)

References 170 publications

(215 reference statements)

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“…A group of key opinion leaders suggested this tool could be used as an awareness tool in order to increase the awareness of the most common symptoms of CMA to aid an earlier diagnosis [ 3 ]. This study confirms that the CoMiSS can be considered as a useful awareness tool for HCPs, what was already previously suggested in a review paper [ 14 ].…”

Section: Discussionsupporting

confidence: 91%

How Are Infants Suspected to Have Cow’s Milk Allergy Managed? A Real World Study Report

Vandenplas

Bělohlávková²,

Enninger

et al. 2021

Nutrients

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The purpose of this study was to evaluate the diagnosis and management of infants presenting with symptoms attributable to cow milk allergy (CMA) in a real life setting and to test how the Cow Milk-related Symptom Score (CoMiSS®) can be used to support awareness and diagnosis of cow’s milk protein allergy in primary care practice. The CoMiSS is an awareness tool based on various symptoms such as crying, gastrointestinal symptoms, dermatological and respiratory symptoms. The study was conducted on 268 infants from four countries (Belgium, Czech Republic, Germany, UK) aged 0 to 18 months consulting for CMA related symptoms. The analysis was based on two visits of these subjects. The results show an average CoMiSS of 11 at the first visit. After a therapeutic dietary intervention, the score at the second visit, which happened 3 weeks ± 5 days after the first, dropped to an average value of 4. A satisfaction questionnaire completed by the primary care practitioners suggested an overall high level of satisfaction with the application of the CoMiSS tool in routine practice. These data highlight a huge discrepancy in the diagnosis and management of infants suspected of CMA in the different countries. The findings suggest that the CoMISS questionnaire is an effective tool in aiding awareness of CMPA in primary health care.

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Section: Discussionsupporting

confidence: 91%

How Are Infants Suspected to Have Cow’s Milk Allergy Managed? A Real World Study Report

Vandenplas

Bělohlávková²,

Enninger

et al. 2021

Nutrients

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“…Briefly, the following sections will discuss issues concerning the dietetic management of these forms, mostly focusing on the use of HF and AAF. A more comprehensive review of pathogenetic and clinical aspects of non-IgE CMA is beyond the scope of the present review as they have been addressed in other publications [ 6 , 72 , 73 ].…”

Section: Hydrolysed Formulas In Cma Treatment: Recommendationsmentioning

confidence: 99%

“…If colic is associated with other allergic signs and symptoms or a family history of atopy, a trial with an eHF for 2 to 8 weeks may be considered a suitable option to investigate the pathogenetic role of CMA [ 6 , 104 ]. A step- by step approach to infants with persistent unexplained regurgitation, vomiting, and crying was recently proposed to help clinicians in managing these infants and deciding time and type of diet intervention, including HF [ 94 ].…”

Section: Hydrolysed Formulas In Gastrointestinal Motility Disordersmentioning

confidence: 99%

“…Most symptoms of non-IgE-mediated FAs involve the digestive tract. Indeed, non-IgE-mediated FAs include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome (FPIES) eosinophilic disorders, including eosinophilic esophagitis (EoE), and a heterogeneous group of non-IgE-mediated disorders more commonly recognized as gastrointestinal motility disorders [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

et al. 2021

Self Cite

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An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.

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“…Mixed FAs include Eosinophilic Gastrointestinal Disorders (EGIDs), such as eosinophilic esophagitis (EoE), allergic eosinophilic gastroenteritis (AEG), and eosinophilic colitis, characterized by gastrointestinal symptoms, eosinophilic infiltration of the gastrointestinal tract, and, sometimes, peripheral eosinophilia [ 12 ]. Generally detected in the first year of life, the clinical picture of EoE includes regurgitation, vomiting, rumination, lack of appetite, burning, and pain, causing crying after feeding and sometimes immediately after starting to feed.…”

Section: Introductionmentioning

confidence: 99%

Monoclonal Antibodies in Treating Food Allergy: A New Therapeutic Horizon

et al. 2021

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Food allergy (FA) is a pathological immune response, potentially deadly, induced by exposure to an innocuous and specific food allergen. To date, there is no specific treatment for FAs; thus, dietary avoidance and symptomatic medications represent the standard treatment for managing them. Recently, several therapeutic strategies for FAs, such as sublingual and epicutaneous immunotherapy and monoclonal antibodies, have shown long-term safety and benefits in clinical practice. This review summarizes the current evidence on changes in treating FA, focusing on monoclonal antibodies, which have recently provided encouraging data as therapeutic weapons modifying the disease course.

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Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

Cited by 51 publications

References 170 publications

How Are Infants Suspected to Have Cow’s Milk Allergy Managed? A Real World Study Report

How Are Infants Suspected to Have Cow’s Milk Allergy Managed? A Real World Study Report

Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

Monoclonal Antibodies in Treating Food Allergy: A New Therapeutic Horizon

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