Nocerino R¹, Di Costanzo M², Bedogni G³, Cosenza L², Maddalena Y², Di Scala C², Della Gatta G², Carucci L², Voto L⁴, Coppola S², Iannicelli AM⁴, Berni Canani R⁵. J Pediatr. 2019 Jul 18. pii: S0022-3476(19)30698-5. doi: 10.1016/j.jpeds.2019.06.004. [Epub ahead of print]

Author information

1 Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy. Electronic address: ritanocerino@alice.it.

2 Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy.

3 Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy.

4 Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.

5 Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy; European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy; Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy.

Abstract

OBJECTIVE: To investigate whether the addition of the probiotic Lactobacillus rhamnosus GG (LGG) to the extensively hydrolyzed casein formula (EHCF) for cow's milk allergy (CMA) treatment could reduce the occurrence of functional gastrointestinal disorders (FGIDs).

STUDY DESIGN: This cohort study included children with a positive history for CMA in the first year of life who were treated with EHCF alone or in combination with LGG and had evidence of immune tolerance acquisition to cow's milk for at least 12 months. FGID was diagnosed according to the Rome III diagnostic criteria by investigators unaware of previous treatment. A cohort of consecutive healthy children was also evaluated as a control population.

RESULTS: A total of 330 subjects were included, 110 per cohort (EHCF, EHCF+LGG, and healthy controls). The rate of subjects with ≥1 FGID was significantly lower in the EHCF+LGG cohort compared with the EHCF cohort (40% vs 16.4%; P < .05). In the EHCF+LGG cohort, a lower incidence was observed for all components of the main study outcome. The prevalence of FGIDs in the healthy cohort was lower than that in the EHCF cohort and similar to that in the EHCF+LGG cohort. The incidence rate ratio of FGIDs for the EHCF+LGG cohort vs the EHCF cohort (0.40; 95% CI, 0.25-0.65; P < .001) was unmodified after correction for age at CMA diagnosis, breastfeeding, weaning time, and presence of a first-degree relative with an FGID.

CONCLUSIONS: These results confirm the increased risk for developing FGIDs in children with CMA and suggest that EHCF+LGG could reduce this risk.