Failure to Thrive in Infants May Be an Early Clinical Marker for Cow’s Milk Allergy

by | May 6, 2020 | 2020, Allergies, Infant and Children's Health

Written by Angeline A. De Leon, Staff Writer. This study shows that failure to thrive (FTT) may be a useful clinical marker for early identification of cow’s milk allergy (CMA), particularly in non-IgE mediated forms of allergy to cow’s milk.

women's healthChildren whose current weight and/or rate of weight gain falls below recognized standards of growth are said to suffer from failure to thrive (FTT), a condition typically related to undernourishment 1. FTT is a complex condition that may or may not necessarily be related to an illness, but research suggests that gastrointestinal allergic disorders may be involved 2. Data indicate that the prevalence of food allergies will continue to increase 3,4, with cow’s milk allergy (CMA) representing the most common type in infants 5. Clinical diagnosis of CMA is difficult, due to the delayed manifestation of symptoms, as well as the diverse and non-specific range of presenting symptomology 6. In testing for clinical CMA, the oral food challenge (OFC) is a popular approach, however, due to the delayed onset of potential symptoms, it requires a relatively prolonged follow-up period 7. An alternative testing method involves a cow’s milk-free diet (CMFD), which when introduced to infants with FTT and followed by steady symptom improvement, is taken to signal a positive diagnosis for CMA 8,9. In a 2020 study 10 published in Nutrients, researchers sought to evaluate FTT as a possible clinical marker for early diagnosis of milk hypersensitivity in infants.

A retrospective, cross-sectional study was carried out in a cohort of 43 full-term infants (58% female, mean age = 5.7 months) with a physician’s diagnosis of FTT. Anthropometric measures were taken, and diet history (feeding schedule, formula preparation, caloric intake, etc.) was obtained based on parents’ self-report. Infants were tested for immunoglobulin E (IgE)-mediated CMA (immediate reaction upon ingestion) using a skin prick test (SPT), an IgE-specific blood test, and the OFC. All infants were assigned to CMFD for 4 to 8 weeks before possible re-introduction of cow’s milk. Based on symptom prevalence during the elimination-re-introduction sequence, a diagnosis of non-IgE-mediated CMA (delayed reaction) was considered for the remainder of infants. At follow-up, growth z-scores were computed based on World Health Organization anthropometric data.

Analyses revealed that of 43 infants, 3 had a diagnosis of IgE-mediated CMA and 10 had a diagnosis of gastro-esophageal reflux disease (GERD). The other 30 infants were diagnosed with non-IgE-mediated CMA, as confirmed by the elimination diet which led to significant symptom improvement during the 4 to 8 CMFD period and was followed by symptom re-emergence after the re-introduction of cow’s milk. In infants aged 6 months or younger, FTT was found to be significantly correlated to CMA (p < 0.001). In 29 of 30 infants with non-IgE-mediated CMA, significant normalization of growth indices was apparent following CMFD: mean z-scores (standard deviation) for weight-for-age, length-for-age, weight-for-length, body mass index-for-age, and head circumference-for-age were 0.1 (0.7), 0.0 (1.2), 0.2 (0.6), 0.2 (0.7), and 0.7 (1.0), respectively (p < 0.001 for all).

Results from the study suggest that FTT should be considered a potential clinical marker for early identification of CMA in infants. Given the difficulty of diagnosing CMA, especially the non-IgE-mediated form, FTT profiling represents a practical approach to recognizing milk hypersensitivity early on. In the current study, CMA was confirmed by introducing a CMFD regimen for a period of weeks. Researchers report that such an elimination diet led to normalization of all growth indices in infants with non-IgE-mediated CMA. Findings suggest that further studies on FTT as a clinical aspect of CMA are warranted. A potential study limitation is the failure to measure physiological biomarkers, such as insulin and blood levels of amino acids, which could provide more detailed data on infant nutrition and metabolism. Given the nature of the present study, trials using a randomized, double-blind, placebo-controlled design are also needed in the future.

Source: Diaferio L, Caimmi D, Verga MC, et al. May failure to thrive in infants be a clinical marker for the early diagnosis of cow’s milk allergy? Nutrients. 2020; 12: 466. DOI: 10.3390/nu12020466.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access  article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Click here to read the full text study.

Posted May 5, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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