Pathophysiology Infant is responding to allergens in moms diet Cows milk protein and soy are most...
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Transcript of Pathophysiology Infant is responding to allergens in moms diet Cows milk protein and soy are most...
Pathophysiology Infant is responding to allergens in mom’s diet
Cows milk protein and soy are most common
Sensitization could start in utero
Occasionally symptoms are seen day 1
Restricting mom’s diet during pregnancy currently not recommended
Large bowel edema, erosions of mucosa, eosinophilic infiltration of the intestinal lining
BMC gastroenterology 2011 11:82
Maternal Elimination DietABM protocol
Start with elimination of cows milk products
Most cases will improve in 72-96 hours No more blood, mucous is gone, stools appear normal
If no change at all after 2 weeks, also eliminate soy. If no change, add dairy and soy back into the diet, and eliminate something else. Continue in this way with other allergens. Citrus fruits, eggs, nuts, peanut, wheat, corn, strawberries,
chocolate
Families need education on how to read food labels to avoid substances of each allergen.
Geographic variability in the most common allergens
Severe Cases
Consider starting with a strict maternal elimination diet
Lamb, pears, squash, rice
Once symptoms resolve, add a new allergen once a week
Addition of pancreatic enzymes
No randomized controlled trials
Theoretically breaks down allergens in mom’s gut before absorption
Two Creon 6000 with each meal, one with each snack
Breastfed Babies Receiving Formula Supplementation
Change to a soy based formula first.
If sx are severe and persistent, change to a hydrolyzed formula, or possibly an amino acid-based formula
Re-introducing Allergens
Consider allergy testing if other allergic symptoms such as eczema, allergies, hives, chronic diarrhea
If baby otherwise well, OK to reintroduce offending allergens 6-9 mo after initial reaction, or wait until 12 mo old
Other Website Resources
Web LinksILCA, Academy of Nutrition and
DieteticsResources for recipesFood allergy information
Future Research
Further defining the relationship between these gastropathies
Incidence in the population
Who is more at risk?
Other means of identifying offending antigens
Further research on maternal treatment such as pancreatic enzymes
Check Out www.infantproctocolitis.org