Food Hypersensitivity and Otolaryngologic Conditions in Young

Objectives/Hypothesis. To explore the relationship between food hypersensitivity and common upper aerodigestive dis- orders 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 otolaryn- gology clinic and compared with a control study group. Results. One hundred ninety-one children with CMPA were reviewed. One hundred forty-one had aerodigestive com- plaints, with 101 having sufficient follow-up to participate in the study. Ninety-one percent of this final patient group demonstrated improved symptoms following dairy elimina- tion. Twenty-five patients (27%) had associated otolaryngo- logic (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 oro- pharyngeal dysphagia (80%). Sixty percent of ENT disease improved with elimination diet. Eosinophilic esophagitis was noted in 36% of the cohort who had mucosal biopsies per- formed. 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 otolaryn- gologic conditions in children younger than 2 years. Some patients in this study showed symptom improvement via an elimination diet. Early recognition of otolaryngologic mani- festations of CMPA may help manage this condition in young children.