title: Cow's milk allergy and neonatal short bowel syndrome: comorbidity or true association?
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Diamanti
authors.affiliation: Allergy Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
authors.forename: A G
authors.initials: AG
authors.lastname: Fiocchi
authors.affiliation: 1] Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy [2] Pediatric Clinic of University, Bari, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Capriati
authors.affiliation: Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Panetta
authors.affiliation: Allergy and Clinical Immunology Unit, 'Anna Meyer' Children's Hospital, Florence, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Pucci
authors.affiliation: Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bellucci
authors.affiliation: Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Torre
mesh_terms: D000818:Animals; D002417:Cattle; D015897:Comorbidity; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D008894:Milk Proteins / Q000276:immunology; D012778:Short Bowel Syndrome / Q000453:epidemiology*; D012882:Skin Tests
chemical_list: D008894:Milk Proteins; D007073:Immunoglobulin E