Pathophysiology
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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

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Pathophysiology

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Pathophysiology

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


Pathophysiology

BMC gastroenterology 2011 11:82


Maternal elimination diet abm protocol

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

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

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

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 moold


Other website resources

Other Website Resources

  • Web Links

    • ILCA, Academy of Nutrition and Dietetics

    • Resources for recipes

    • Food allergy information


Future research

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

Check Out www.infantproctocolitis.org


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