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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
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
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
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