Food hypersensitivity and otolaryngologic conditions in young children

Otolaryngol Head Neck Surg. 2012 Aug;147(2):215-20. doi: 10.1177/0194599812441573. Epub 2012 Mar 23.


Objectives/hypothesis: To explore the relationship between food hypersensitivity and common upper aerodigestive disorders found in children younger than 2 years.

Study design: Case control study.

Setting: Tertiary pediatric gastroenterology/otolaryngology clinics.

Methods: Two-year retrospective chart review of a common cohort of children younger than 2 years with suspected cow's milk protein allergy (CMPA). Patients were managed in both a tertiary pediatric gastroenterology and otolaryngology clinic and compared with a control study group.

Results: One hundred ninety-one children with CMPA were reviewed. One hundred forty-one had aerodigestive complaints, with 101 having sufficient follow-up to participate in the study. Ninety-one percent of this final patient group demonstrated improved symptoms following dairy elimination. Twenty-five patients (27%) had associated otolaryngologic (ear, nose, and throat [ENT]) issues that had been refractory to maximal gastroesophageal reflux therapy. The most common associated upper aerodigestive conditions were persistent upper airway congestion (72%) and oropharyngeal dysphagia (80%). Sixty percent of ENT disease improved with elimination diet. Eosinophilic esophagitis was noted in 36% of the cohort who had mucosal biopsies performed. Otolaryngology intervention was much more common in the cohort of children with CMPA compared with controls (odds ratio, 33.78; 95% confidence interval, 7.55, 151.03).

Conclusions: CMPA is difficult to diagnose because of limited accurate diagnostic tools, especially in young children. This study suggests a relationship between CMPA and otolaryngologic conditions in children younger than 2 years. Some patients in this study showed symptom improvement via an elimination diet. Early recognition of otolaryngologic manifestations of CMPA may help manage this condition in young children.

MeSH terms

  • Case-Control Studies
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Milk Hypersensitivity / complications*
  • Milk Hypersensitivity / etiology*
  • Milk Proteins / adverse effects*
  • Milk Proteins / immunology
  • Otorhinolaryngologic Diseases / complications*
  • Retrospective Studies


  • Milk Proteins