Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation

Abstract

BackgroundAllergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formulaMethodsWe have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy.ResultsPrick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.ConclusionsThese data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding.

Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy

“…Lucarelli et al in 2011 found APT to be helpful in identifying those infants who required extensively hydrolyzed formula due to persistent symptoms despite elimination of the most common inciting foods. However, this study was small (14 infants) and without controls for comparison; further study is need to validate these findings [47].…”

“…In a study including 95 breastfed infants, stools normalized with sequential elimination of potential triggers from the maternal diet as follows: 65 % improved with elimination of cow's milk, 19 % with egg, 6 % with corn, and 3 % with soy [5].Five percent of infants were sensitized to multiple foods [5]. There are reports of infants with persistent symptoms despite removal of the above-mentioned foods; these infants' stools have improved on extensively hydrolyzed formula, suggesting that there are likely other inciting foods in FPIAP that have not yet been identified [47,63].…”

Síntomas digestivos y respuesta clínica en lactantes con alergia a la proteína de leche de vaca

“…Se excluyeron historias clínicas de lactantes que no tuvieron prueba de eliminación y provocación abierta o que hubieran consultado por otras causas: síndrome de malabsorción, enfermedades metabólicas, hepáticas, renales, etc. 1,[3][4][5][6][7][8]10,[16][17][18][19][20]22,23,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] .La Información de las historias clínicas, fue recolectada del sistema de información HIS-ISIS ® del HU-FSFB y MEDSYS V4.0 ® de la Asociación Médica de los Andes (AMA), en un cuestionario. Se realizó una prueba piloto en 10 pacientes.…”

Alergia a la leche y al huevo: diagnóstico, manejo e implicaciones en América Latina

“…Debido al paso placentario, en los niños altamente sensibles puede ser necesario que la madre evite el consumo de leche y sus derivados para evitar suministrar péptidos de la leche de vaca al lactante a través de la leche materna (39). También se debe considerar la necesidad del suministro de vitamina D y de calcio de manera individualizada.…”