Multiple food allergy: a possible diagnosis in breastfed infants

Abstract

Six infants suspected of food allergy during breastfeeding were evaluated using prick tests, total IgE, RASTs and intestinal permeability measurements during fast and provocation with mother's milk. An elimination diet was undertaken in mothers, removing first cow's milk protein (CMP), then, when inefficient, all foods suspected on the clinical history or a positive prick test in the child, followed by oral challenges in mother's diet with the corresponding food. The sole CMP-free diet in mothers always proved insufficient. In four, an additional diet excluding two to three other foods cleared the symptoms. Oral provocations in mother's diet with those foods were positive in all. In two, mothers turned down a diet excluding more than four foods, symptoms cleared while feeding the child with an extensively hydrolysed formula, whereas challenges with mother's milk induced immediate reactions. Intestinal permeability was altered during provocation tests with mother's milk sampled before maternal diet. Food allergy during breastfeeding may be due to multiple foods and the inefficacy of the sole CMP elimination in mothers does not rule out food sensitization.

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

“…100,101 Unusual clinical presentations of CMA Unusual clinical presentations are as much a feature of CMA as one might expect from such a ubiquitous allergen source in food and the environment as milk (Box 1). [102][103][104][105][106][107][108][109][110][111][112] The natural history of CMA CMA is primarily of pediatric onset, [113][114][115] is generally outgrown, and is often the first stage of the ''allergic march.'' The take-home message about the latest developments regarding the natural history of CMA is reviewed in Table II.…”

Gastroesophageal Reflux and Cow Milk Allergy: Is There a Link?

“…102 More recent, reactions to CMP in breastfed infants were reported in approximately 0.5% 15 and an increasing number of exclusively breastfed infants become sensitized to multiple antigens very early in life. [103][104][105][106] No difference in incidence of regurgitation was reported in relation to breastfeeding or formula-feeding. [105][106][107] Comparing 37 breastfed to formula-fed healthy neonates, breast milk was associated with less and shorter reflux episodes 3 and 4 hours after feeding, although there was no significant difference in episodes per hour between the 2 groups.…”

Session 1: Allergic disease The challenges of managing food hypersensitivity

“…However, infants suffering from non-IgE-mediated food-induced gastro-enterocolitisproctitis syndromes with failure to thrive, severe eczema and severe reflux oesophagitis or with symptoms during exclusive breast-feeding are more likely to benefit from AAF than eHF. Infants on AAF also seem to have better longitudinal growth than infants on eHF (54,55) . It has also been recommended that infants presenting with severe manifestations of cow's milk-protein allergy such as failure to thrive, hypoproteinaemia and hypoalbuminaemia or Fe-deficiency anaemia should start with AAF (56) .…”