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Protein Intolerance

  • Author: Agostino Nocerino, MD, PhD; Chief Editor: Carmen Cuffari, MD  more...
Updated: Aug 01, 2014


Many food proteins can act as antigens in humans. Cow's milk proteins are most frequently implicated as a cause of food intolerance during infancy. Soybean protein ranks second as an antigen in the first months of life, particularly in infants with primary cow's milk intolerance who are placed on a soy formula. From school age on, egg protein intolerance becomes more prevalent.

Food protein intolerance can be immunoglobulin E (IgE)-mediated or non-IgE-mediated. Local production and systemic distribution of specific reaginic IgE plays a significant role in IgE-mediated reactions to food proteins.

Several clinical reactions to food proteins have been reported in children and adults. Only a few of these have a clear allergic IgE-mediated pathogenesis. For this reason, the term "food protein intolerance" is usually preferred to "food protein allergy," in order to include all offending specific reactions to food proteins, no matter the pathogenesis. In children, GI symptoms are generally most common, with a frequency ranging from 50-80%, followed by cutaneous symptoms (20-40%), and respiratory symptoms (4-25%).



The major food allergens are water-soluble glycoproteins (molecular weight [MW], 10,000-60,000) that are resistant to heat, acid, and enzymes.

Studies have demonstrated that food allergens are transported in large quantities across the epithelium by binding to cell surface IgE/CD23, which opens a gate for intact dietary allergens to transcytose across the epithelial cells that protect the antigenic protein from lysosomal degradation in enterocytes.[1]

Some antigens can move through intercellular gaps ; however, the penetration of antigens through the mucosal barrier is not usually associated with clinical symptoms. Under normal circumstances, food antigen exposure via the GI tract results in a local immunoglobulin A (IgA) response and in an activation of suppressor CD8+ lymphocytes that reside in the gut-associated lymphoid tissue (oral tolerance).

In some children who are genetically susceptible, or for other as-of-yet-unknown reasons, oral tolerance does not develop, and different immunologic and inflammatory mechanisms can be elicited.[2] Whether nonimmunologic mechanisms can have a role in the development of specific intolerances to food proteins is still disputed.

Some evidence suggests that reduced microbial exposure during infancy and early childhood result in a slower postnatal maturation of the immune system through a reduction of the number of T regulatory (Treg) cells and a possible delay in the progression to an optimal balance between TH1 and TH2 immunity, which is crucial to the clinical expression of allergy and asthma (hygiene hypothesis).[3] Genetic variations in receptors for bacterial products are likely to be related to allergic sensitizations. On the other hand, intestinal infections may increase paracellular permeability, allowing the absorption of food proteins without epithelial processing. As a consequence, infectious exposures can be an important contributory factor in the pathogenesis of food protein allergies.

Many immunologic reactions to food allergens are IgE-mediated and usually target several different epitopes. Certain epitopes are homologous in different foods.

Non-IgE mediated food allergies involve T-cell mediated immunity to certain food proteins. and large amounts of inflammatory cytokines such as TNF-α are produced by T cells in an antigen-specific manner. TNF-α increases intestinal permeability, which facilitates the uptake of undigested food antigens.

In both IgE-mediated and non-IgE-mediated food allergies, Th2 cytokines (such as IL-4, IL-5 and IL-13) are produced by T cells in response to specific food antigens. However, the precise mechanisms and pathogenesis of GI allergy remain unclear.[4]

Eosinophilic gastrointestinal diseases (EGIDs) have been classified as a combined IgE-mediated and cell-mediated disease because many patients have detectable food-specific IgE antibodies. However, the roles of IgE antibodies in the pathogenesis of EGID remain unclear.[5, 5]

Morphologic studies have demonstrated the role of GI T lymphocytes (ie, intraepithelial lymphocytes) in the pathogenesis of GI food allergy. The pathogenic role of the eosinophils in food-induced eosinophilic GI diseases has not been defined. Vast evidence describes the occurrence of immunoglobulin G (IgG) food protein antibodies. However, their actual role in the pathogenesis of clinically relevant symptoms is, at best, doubtful.

Cow's milk proteins

Cow's milk contains more than 20 protein fractions. In the curd, 4 caseins (ie, S1, S2, S3, S4) can be identified that account for about 80% of the milk proteins. The remaining 20% of the proteins, essentially globular proteins (eg, lactalbumin, lactoglobulin, bovine serum albumin), are contained in the whey. Casein is often considered poorly immunogenic because of its flexible, noncompact structure. Historically, lactoglobulin has been accepted as the major allergen in cow's milk protein intolerance. However, polysensitization to several proteins is observed in about 75% of patients with allergy to cow's milk protein.

The proteins most frequently and most intensively recognized by specific IgE are the lactoglobulin and the casein fraction. However, all milk proteins appear to be potential allergens, even those that are present in milk in trace amounts (eg, serum bovine albumin, immunoglobulins, lactoferrin). In each allergen, numerous epitopes can be recognized by specific IgE presence. Cow's milk proteins introduced with maternal diet can be transferred to the human milk. Many studies have focused on the presence of bovine lactoglobulin throughout human lactation. The GI tract is permeable to intact antigens. The antigen uptake is an endocytotic process that involves intracellular lysosomes.

Cow's milk proteins introduced with maternal diet can be transferred to the human milk. Many studies have focused on the presence of bovine lactoglobulin throughout human lactation.

Antigen uptake has been found to be increased in children with gastroenteritis and with cow's milk allergy.

The classification of different clinical presentations of food intolerance in children based on their presumptive underlying pathophysiological mechanisms is below.

Non–immune-mediated reactions

See the list below:

  • Disorders of digestive-absorptive process
    • Glucose-galactose malabsorption
    • Lactase deficiency
    • Sucrase-isomaltase deficiency
    • Enterokinase deficiency
  • Pharmacological reactions
    • Tyramine in aged cheeses
    • Histamine (eg, in strawberries, caffeine)
  • Idiosyncratic reactions
    • Food additives
    • Food colorants
  • Inborn errors of metabolism
    • Phenylketonuria
    • Hereditary fructose intolerance
    • Tyrosinemia
    • Galactosemia
    • Lysinuric protein intolerance

Immune-mediated (food allergy)

See the list below:

  • IgE-mediated (positive radioallergosorbent test or skin prick test results)
    • Oral allergy syndrome
    • Immediate GI hypersensitivity
  • Occasionally IgE-mediated
    • Eosinophilic esophagitis
    • Eosinophilic gastritis
    • Eosinophilic gastroenteritis
  • Non-IgE-mediated - Food protein–induced entities (eg, enterocolitis, enteropathy, proctocolitis, chronic constipation)


See the list below:

  • Innate and adaptive immunity - Celiac disease



United States

In a national survey of pediatric allergists, the prevalence rate of cow's milk allergy was reported to be 3.4%, whereas the prevalence rate of soy protein allergy was 1.1%. During the 10-year period of 1997-2006, food allergy rates significantly increased among both preschool-aged and older children.[6] In 2007, the reported food allergy rate among all children younger than 18 years was 18% higher than in 1997.


Incidence of food allergy in children has been variously estimated at 0.3-8%, and the incidence decreases with age. Food allergies affect 6-8% of infants younger than 2 years. In a cohort of 1,749 newborns from the municipality of Odense in Denmark who were prospectively monitored for the development of cow's milk protein intolerance during the first year of life, a 1-year incidence of 2.2% was reported.[7]

Varying incidences of specific intolerances have been reported in different countries. Whether these differences are due to genetic or cultural factors is unclear.[8]

To evaluate the prevalence of food allergy among different countries in Europe, the EuroPrevall project was launched in June 2005. Subsequently, the EuroPrevall-INCO project has been developed to evaluate the prevalence of food allergies in China, India, and Russia.[9]


Most of the cases of food protein intolerance can be resolved with dietary management. A few cases of severe anaphylactic reactions to food proteins have been reported. A report from the United Kingdom suggests an incidence of 0.22 severe cases per 100.000 children per year (15% of cases were fatal or near fatal).[10]


No race predilection has been observed.


No sex predilection is known, but males are slightly more frequently affected with eosinophilic gastroenteritis.


Food allergy is mainly a problem in infancy and early childhood. Cow's milk allergy or intolerance usually develops in early infancy. In most of the cases, the onset of symptoms is closely related to the time of introduction of formula based on cow's milk.

In a prospective study from Norway, the prevalence of atopic dermatitis in the first 2 years was 18.6% with no significant difference between preterm and term children. Adverse reactions to food were found in 15.8% (a similar prevalence in premature and term children). Mode of delivery did not affect prevalence of atopic dermatitis.[11] An example is shown in the image below.

Typical atopic dermatitis on the face of an infant Typical atopic dermatitis on the face of an infant.

An unselected prospective study indicated that 42% of infants who developed cow's milk protein intolerance were symptomatic within 7 days (70% within 4 wk) following the introduction of cow's milk.[6] Cow's milk protein intolerance has been diagnosed in 1.9-2.8% of general populations of infants aged 2 years or younger in different countries of northern Europe, but incidence fell to approximately 0.3% in children older than 3 years.

Protein intolerance is generally believed to remit by age 5 years, when the infant's mucosal immune system matures and the child becomes immunologically tolerant of milk proteins; in most affected children, symptoms resolve by age 1-2 years. However, cow's milk protein intolerance may persist or may initially manifest in older children, demonstrating characteristic endoscopic and histopathologic features; it occasionally recurs in adults.

Studies have suggested increased persistence of food allergies (albeit ones possibly affected by selection bias); possible explanations have been primarily focused on peanut intolerance.[12]

Contributor Information and Disclosures

Agostino Nocerino, MD, PhD Chief of Pediatric Oncology, Department of Pediatrics, University of Udine, Italy

Agostino Nocerino, MD, PhD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, Italian Society of Pediatric Hematology and Oncology, Italian Society of Pediatric Emergency and Urgent Care Medicine, Italian Society of Pediatrics

Disclosure: Nothing to disclose.


Stefano Guandalini, MD Founder and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Chris A Liacouras, MD Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

  1. Yu LC. The epithelial gatekeeper against food allergy. Pediatr Neonatol. 2009 Dec. 50(6):247-54. [Medline].

  2. DePaolo RW, Abadie V, Tang F, Fehlner-Peach H, Hall JA, Wang W. Co-adjuvant effects of retinoic acid and IL-15 induce inflammatory immunity to dietary antigens. Nature. 2011 Mar 10. 471(7337):220-4. [Medline].

  3. Sironi M, Clerici M. The hygiene hypothesis: An evolutionary perspective. Microbes Infect. 2010 Feb 21. [Medline].

  4. Morita H, Nomura I, Matsuda A, Saito H, Matsumoto K. Gastrointestinal food allergy in infants. Allergol Int. 2013 Sep. 62(3):297-307. [Medline].

  5. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. 2004 Jan. 113(1):11-28; quiz 29. [Medline].

  6. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. 2008 Oct. (10):1-8. [Medline].

  7. Assa'ad A. Eosinophilic gastrointestinal disorders. Allergy Asthma Proc. 2009 Jan-Feb. 30(1):17-22. [Medline].

  8. Hill DJ, Hosking CS, Heine RG. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Ann Med. 1999 Aug. 31(4):272-81. [Medline].

  9. Wong GW, Mahesh PA, Ogorodova L, et al. The EuroPrevall-INCO surveys on the prevalence of food allergies in children from China, India and Russia: the study methodology. Allergy. 2009 Nov 4. [Medline].

  10. Colver AF, Nevantaus H, Macdougall CF, Cant AJ. Severe food-allergic reactions in children across the UK and Ireland, 1998-2000. Acta Paediatr. 2005 Jun. 94(6):689-95. [Medline].

  11. Kvenshagen B, Jacobsen M, Halvorsen R. Atopic dermatitis in premature and term children. Arch Dis Child. 2009 Mar. 94(3):202-5. [Medline].

  12. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010 Feb. 125(2 Suppl 2):S116-25. [Medline].

  13. Straumann A, Aceves SS, Blanchard C, Collins MH, Furuta GT, Hirano I. Pediatric and adult eosinophilic esophagitis: similarities and differences. Allergy. 2012 Apr. 67(4):477-90. [Medline].

  14. Aceves SS, Newbury RO, Dohil MA, Bastian JF, Dohil R. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation. Ann Allergy Asthma Immunol. 2009 Nov. 103(5):401-6. [Medline].

  15. Binkovitz LA, Lorenz EA, Di Lorenzo C, Kahwash S. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation. Pediatr Radiol. 2010 May. 40(5):714-9. [Medline].

  16. Ozdemir O, Mete E, Catal F, Ozol D. Food intolerances and eosinophilic esophagitis in childhood. Dig Dis Sci. 2009 Jan. 54(1):8-14. [Medline].

  17. Rothenberg ME, Spergel JM, Sherrill JD, Annaiah K, Martin LJ, Cianferoni A. Common variants at 5q22 associate with pediatric eosinophilic esophagitis. Nat Genet. 2010 Apr. 42(4):289-91. [Medline].

  18. Mehr SS, Kakakios AM, Kemp AS. Rice: a common and severe cause of food protein-induced enterocolitis syndrome. Arch Dis Child. 2009 Mar. 94(3):220-3. [Medline].

  19. Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. 2006 Aug. 17(5):351-5. [Medline].

  20. Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 2005 Jan. 115(1):149-56. [Medline].

  21. Hwang JB, Song JY, Kang YN, et al. The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical cow''s milk protein-induced enterocolitis. J Korean Med Sci. 2008 Apr. 23(2):251-5. [Medline]. [Full Text].

  22. Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2009 Jun. 94(6):425-8. [Medline].

  23. Maloney J, Nowak-Wegrzyn A. Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol. 2007 Jun. 18(4):360-7. [Medline].

  24. Behjati S, Zilbauer M, Heuschkel R, et al. Defining eosinophilic colitis in children: insights from a retrospective case series. J Pediatr Gastroenterol Nutr. 2009 Aug. 49(2):208-15. [Medline].

  25. Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002. 13 Suppl 15:23-8. [Medline].

  26. Kokkonen J, Tikkanen S, Karttunen TJ, Savilahti E. A similar high level of immunoglobulin A and immunoglobulin G class milk antibodies and increment of local lymphoid tissue on the duodenal mucosa in subjects with cow's milk allergy and recurrent abdominal pains. Pediatr Allergy Immunol. 2002 Apr. 13(2):129-36. [Medline].

  27. Walker WA. Cow's milk protein-sensitive enteropathy at school age: a new entity or a spectrum of mucosal immune responses with age. J Pediatr. 2001 Dec. 139(6):765-6. [Medline].

  28. Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. 1998 Oct 15. 339(16):1100-4. [Medline].

  29. [Guideline] Plaut M, Sawyer RT, Fenton MJ. Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. J Allergy Clin Immunol. 2009 Oct. 124(4):671-8.e1. [Medline].

  30. [Guideline] Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S. Diagnostic approach and management of cow's milk protein allergy in infants and children: A practical guideline of the GI-committee of ESPGHAN. J Pediatr Gastroenterol Nutr. 2012 May 7. [Medline].

  31. Niggemann B, Beyer K. Diagnosis of food allergy in children: toward a standardization of food challenge. J Pediatr Gastroenterol Nutr. 2007 Oct. 45(4):399-404. [Medline].

  32. [Guideline] Cox L, Williams B, Sicherer S, Oppenheimer J, Sher L, Hamilton R. Pearls and pitfalls of allergy diagnostic testing: report from the American College of Allergy, Asthma and Immunology/American Academy of Allergy, Asthma and Immunology Specific IgE Test Task Force. Ann Allergy Asthma Immunol. 2008 Dec. 101(6):580-92. [Medline].

  33. [Guideline] Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010 Dec. 126(6 Suppl):S1-58. [Medline].

  34. Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S, Vieths S. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy. 2008 Jul. 63(7):793-6. [Medline].

  35. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul. 128(1):3-20.e6; quiz 21-2. [Medline].

  36. Frew AJ. Sublingual immunotherapy. N Engl J Med. 2008 May 22. 358(21):2259-64. [Medline].

  37. Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy. 2007 Nov. 62(11):1261-9. [Medline].

  38. Wang J, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Allergy Asthma Immunol Res. 2009 Oct. 1(1):19-29. [Medline]. [Full Text].

  39. Lack G. Clinical practice. Food allergy. N Engl J Med. 2008 Sep 18. 359(12):1252-60. [Medline].

  40. Kull I, Bergstrom A, Lilja G, Pershagen G, Wickman M. Fish consumption during the first year of life and development of allergic diseases during childhood. Allergy. 2006 Aug. 61(8):1009-15. [Medline].

  41. [Guideline] Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan. 121(1):183-91. [Medline].

  42. Iacono G, Di Prima L, D'Amico D, Scalici C, Geraci G, Carroccio A. The "red umbilicus": a diagnostic sign of cow's milk protein intolerance. J Pediatr Gastroenterol Nutr. 2006 May. 42(5):531-4. [Medline].

  43. Foucard T, Malmheden Yman I. A study on severe food reactions in Sweden--is soy protein an underestimated cause of food anaphylaxis?. Allergy. 1999 Mar. 54(3):261-5. [Medline].

  44. Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. 2008 Jan. 121(1):e44-52. [Medline].

  45. Nwaru BI, Erkkola M, Ahonen S, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics. 2010 Jan. 125(1):50-9. [Medline].

  46. [Guideline] Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan. 121(1):183-91. [Medline].

  47. Kleinman RE. Food sensitivity. American Academy of Pediatrics. Pediatric Nutrition Handbook. 6th. Elk Grove, IL: 2009. 783-799.

  48. Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006 Oct 18. CD003741. [Medline].

  49. [Guideline] Allen KJ, Davidson GP, Day AS, et al. Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health. 2009 Sep. 45(9):481-6. [Medline].

  50. Axelsson I, Jakobsson I, Lindberg T, Benediktsson B. Bovine beta-lactoglobulin in the human milk. A longitudinal study during the whole lactation period. Acta Paediatr Scand. 1986 Sep. 75(5):702-7. [Medline].

  51. Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol. 1986 Jan. 39(1):1-7. [Medline].

  52. Bock SA. Evaluation of IgE-mediated food hypersensitivities. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S20-7. [Medline].

  53. [Guideline] Caffarelli C, Baldi F, Bendandi B, et al. Cow''s milk protein allergy in children: a practical guide. Ital J Pediatr. 2010 Jan 15. 36(1):5. [Medline]. [Full Text].

  54. Carroccio A, Montalto G, Custro N, et al. Evidence of very delayed clinical reactions to cow's milk in cow's milk-intolerant patients. Allergy. 2000 Jun. 55(6):574-9. [Medline].

  55. [Guideline] Darsow U, Wollenberg A, Simon D, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol. 2009 Aug 31. [Medline].

  56. Dupont C, Heyman M. Food protein-induced enterocolitis syndrome: laboratory perspectives. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S50-7. [Medline].

  57. [Guideline] Ebisawa M. Management of food allergy in Japan "food allergy management guideline 2008 (revision from 2005)" and "guidelines for the treatment of allergic diseases in schools". Allergol Int. 2009 Dec. 58(4):475-83. [Medline].

  58. [Guideline] Garcia BE, Gamboa PM, Asturias JA, et al. Guidelines on the clinical usefulness of determination of specific immunoglobulin E to foods. J Investig Allergol Clin Immunol. 2009. 19(6):423-32. [Medline].

  59. Guandalini S, Newland C. Differentiating food allergies from food intolerances. Curr Gastroenterol Rep. 2011 Oct. 13(5):426-34. [Medline].

  60. Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr. 1986 Aug. 109(2):270-6. [Medline].

  61. Hill DJ, Heine RG, Cameron DJ, Francis DE, Bines JE. The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance. J Pediatr. 1999 Jul. 135(1):118-21. [Medline].

  62. Hong X, Tsai HJ, Wang X. Genetics of food allergy. Curr Opin Pediatr. 2009 Dec. 21(6):770-6. [Medline].

  63. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007 Apr. 119(4):1019-21. [Medline].

  64. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S28-35. [Medline].

  65. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995 Nov. 109(5):1503-12. [Medline].

  66. Kokkonen J, Haapalahti M, Laurila K, Karttunen TJ, Maki M. Cow's milk protein-sensitive enteropathy at school age. J Pediatr. 2001 Dec. 139(6):797-803. [Medline].

  67. Kokkonen J, Karttunen TJ, Niinimäki A. Lymphonodular hyperplasia as a sign of food allergy in children. J Pediatr Gastroenterol Nutr. 1999 Jul. 29(1):57-62. [Medline].

  68. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007 Jan. 119(1):192-8. [Medline].

  69. Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S58-60. [Medline].

  70. Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. 1982 Dec. 101(6):906-10. [Medline].

  71. Leung AK. Food allergy: a clinical approach. Adv Pediatr. 1998. 45:145-77. [Medline].

  72. Liacouras CA, Ruchelli E. Eosinophilic esophagitis. Curr Opin Pediatr. 2004 Oct. 16(5):560-6. [Medline].

  73. Lindberg T. Infantile colic: aetiology and prognosis. Acta Paediatr. 2000 Jan. 89(1):1-2. [Medline].

  74. Lowichik A, Weinberg AG. A quantitative evaluation of mucosal eosinophils in the pediatric gastrointestinal tract. Mod Pathol. 1996 Feb. 9(2):110-4. [Medline].

  75. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009 Mar. 123(3):e459-64. [Medline].

  76. Murch S. Food allergies. Guandalini S. Ed. Textbook of pediatric gastroenterology and nutrition. London: Taylor & Francis; 2004.

  77. Niggemann B, Beyer K. Pitfalls in double-blind, placebo-controlled oral food challenges. Allergy. 2007 Jul. 62(7):729-32. [Medline].

  78. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004 Aug 26. 351(9):940-1. [Medline].

  79. Novembre E, Vierucci A. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy. 2001. 56 Suppl 67:105-8. [Medline].

  80. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2003. CD003664. [Medline].

  81. [Guideline] Plaut M, Sawyer RT, Fenton MJ. Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. J Allergy Clin Immunol. 2009 Oct. 124(4):671-8.e1. [Medline].

  82. [Guideline] Rance F, Deschildre A, Villard-Truc F, et al. Oral food challenge in children: an expert review. Eur Ann Allergy Clin Immunol. 2009 Apr. 41(2):35-49. [Medline].

  83. Rothenberg ME. VEGF obstructs the lungs. Nat Med. 2004 Oct. 10(10):1041-2. [Medline].

  84. Sampson HA, Anderson JA. Summary and recommendations: Classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S87-94. [Medline].

  85. Sicherer SH. Food protein-induced enterocolitis syndrome: clinical perspectives. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S45-9. [Medline].

  86. Szajewska H, Setty M, Mrukowicz J, Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. J Pediatr Gastroenterol Nutr. 2006 May. 42(5):454-75. [Medline].

  87. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. 2007 Jan. 119(1):184-91. [Medline].

  88. Tlaskalova-Hogenova H, Tuckova L, Lodinova-Zadnikova R, et al. Mucosal immunity: its role in defense and allergy. Int Arch Allergy Immunol. 2002 Jun. 128(2):77-89. [Medline].

Typical atopic dermatitis on the face of an infant.
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