Persistent ear, nose, and throat (ENT) problems in babies and toddlers could be related to food allergies, and in particular to cow's milk protein, researchers said this week in San Francisco at the Annual Meeting & OTO EXPO of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF).
Conditions such as refractory otitis media or oropharyngeal dysphagia often improve if the children are put on elimination diets, said Dr Angela Paddack from the University Of Arkansas School Of Medicine in Little Rock.
"Food hypersensitivity is a pretty common diagnosis. These kids have gastrointestinal issues, but a subset has ENT conditions, and they do not improve with standard reflux therapy," Dr Paddack told Reuters Health. "These kids will improve when you put them on an elimination diet to rule out cow's milk protein allergy."
She and her colleagues did a chart review on 101 youngsters with suspected cow's milk protein allergy who had been seen in gastroenterology and otolaryngology clinics.
The children had gastrointestinal symptoms including diarrhoea, vomiting, reflux, and constipation. When they were put on a diet that eliminated all cow's milk, 91% of them improved.
Twenty-five of the children who improved were found to have ENT issues that had not responded to maximal gastroesophageal/intestinal reflux therapy.
The most common were oropharyngeal dysphagia in 80%, and persistent upper airway congestion in 72%.
Chronic inflammatory response
60% of the children with ENT disease improved with an elimination diet, Dr Paddack reported.
"Allergy to cow's milk can cause the same reaction in the upper airway as it does in the gut," she added. "These kids get a chronic inflammatory response. One of the main symptoms our patients had was chronic congestion, which often required the need for air tubes."
"They also had swallowing difficulties which caused a lot of problems with eating," Dr Paddack said. "Our main point basically is to tell ENTs that when they have a kid who has these symptoms that do not improve with traditional management, they should think of cow's milk protein allergy as a possible cause."
(Reuters Health, September 2011)