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Maternal and pediatric nutrition

Cow’s milk allergy and neonatal short bowel syndrome: comorbidity or true association?

European Journal of Clinical Nutrition volume 69, pages 102–106 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Neonatal short bowel syndrome (SBS) follows early intestinal resections that may expose the children to increased intestinal contact with undigested food proteins and to the risk of food allergy. We report three consecutive cases of cow's milk allergy (CMA) in SBS infants.

Subjects/Methods:

We reviewed three cases of CMA developed in 37 children with neonatal SBS followed up in the last 10 years. The setting of the survey was the Gastroenterology-Hepatology and Nutrition Unit of the Pediatric Hospital ‘Bambino Gesù’ in Rome. The diagnosis of CMA was based on the oral food challenge and was supported by the results of the skin prick tests (SPT) and/or the specific immunoglobulin (Ig) E.

Results:

Two patients had persistent liquid stools and periodic episodes of vomiting when they were fed with an intact milk protein-based formula, that disappeared with extensively hydrolyzed formula and amino-acid-based formulae, respectively. The third patient developed maculo-papular rash, flushing and angioedema, when he was introduced a regular formula. The challenge-confirmed CMA in all patients. Positive specific IgE for milk proteins was documented in all the three patients. Two out of the three patients had positive familial history for allergy and positive SPT.

Conclusions:

Our findings suggest that the SBS patients require a careful clinical monitoring of the tolerance for the cow’s milk proteins, because CMA could be more frequent than expected. A prospective regular assessment for the potential cow milk sensitization by SPT and specific IgE may clarify the nature of the association and support the clinical surveillance. Multicenter studies are required to better evaluate this comorbidity.

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Authors and Affiliations

  1. Artificial Nutrition Unit–Gastroenterology, Hepatology and Nutrition Unit, ‘Bambino Gesù’ Children’s Hospital, Rome, Italy

    A Diamanti, T Capriati, F Panetta, F Bellucci & G Torre

  2. Allergy Unit, ‘Bambino Gesù’ Children’s Hospital, Rome, Italy

    A G Fiocchi

  3. Pediatric Clinic of University, Bari, Italy

    T Capriati

  4. Allergy and Clinical Immunology Unit, ‘Anna Meyer’ Children's Hospital, Florence, Italy

    N Pucci

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  1. A Diamanti
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  2. A G Fiocchi
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Correspondence to A Diamanti.

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Diamanti, A., Fiocchi, A., Capriati, T. et al. Cow’s milk allergy and neonatal short bowel syndrome: comorbidity or true association?. Eur J Clin Nutr 69, 102–106 (2015). https://doi.org/10.1038/ejcn.2014.156

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