Approach to the spectrum of infant non-IgE-mediated food allergy manifestations and physiologic infant behaviors

Physiologic infant behaviors and symptoms of pathologic conditions such as gastroesophageal reflux disease, IgEmediated food allergy, eosinophilic esophagitis, and other non-IgE-mediated food allergy (including food protein-induced allergic proctocolitis, acute and chronic forms of food protein-induced enterocolitis syndrome, and food protein-induced enteropathy) may have significant overlap, leading to diagnostic uncertainty for primary care physicians and pediatric subspecialists alike. Here we explore the clinical features of gastroesophageal reflux disease and IgE-mediated and non-IgE-mediated food allergy in infants, highlighting the considerable similarities in symptomology and difficulties in ascertaining an accurate diagnosis. Utilizing case studies, we discuss diagnostic and management pearls and review the ramifications of delayed diagnosis or misdiagnosis of infant food allergy for both infants and their caregivers.