Tuesday, November 15, 2016

Allergic Proctocolitis in the Exclusively Breastfed Infant

Dr. Boies answers question at a recent San Diego Breastfeeding Coalition meeting.

Can food protein induced allergy happens to exclusively breastfed infants? The answer is yes, according to Dr. Eyla Boies (MD, FABM, FAAP), a clinical professor of pediatrics at UCSD.

Many confuse allergy wit tolerance. There is a difference. A true food allergy causes an immune system reaction that affects numerous organ in the body. It can cause a range of symptoms. In some cases, an allergic reaction to food can be severe and even life-threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems.

The most common foods implicated in food allergies in breastfed infants include cow's milk, egg, soy, wheat, peanuts, tree nuts, fish, shellfish, sesame seeds, and corn. Other common foods include pork, tomatoes, onions, cabbage and berries. Cow's milk protein(CMP) is the most common food allergens in young children, with 2% of children under four years old allergic to CMP. The severity of a food reaction is generally related to the degree of baby's sensitivity. Meanwhile, cow's milk allergy is uncommon in adults; less than 0.5% of adults are allergic to CMP.

Food protein can induce enterocolits, protocolitis and enteropathy. When food protein induced enterocolitis and enteropathy happen, there will be an acute vomiting pallor one to four hours after food ingestion, and a chronic moderate to severe bloody stools with chronic diarrhea. Both diseases are rare in breastfed infant: Currently there are only 14 cases in the literature. Breastfeeding is likely to protect babies from them. Food protein induced protocolitis is considered a milder form of the spectrum of food induced allergy. It seen to be more often in breastfed infants (less than 60%) whose mothers are consuming cow's milk, sometimes soy or egg, compared to formula fed infants.

Food protein may also plays a role in gastroesophageal reflux disease (GERD), colic and eczema. Colic may be a result or an allergy to make protein in formula fed babies. Much more rarely, colic may be a reaction to specific foods in mom's diet in breastfed babies. An 1983 study found that cow's milk proteins can cause infantile colic in breastfed infants. Another 2005 study found that exclusion of allergic foods from the maternal diet was associated with a reduction in distressed behavior among breastfed infants with colic presenting in the first 6 weeks of life.

Management plans for food protein allergies in the exclusively breastfed infant can be formulated. DR. Boies recommends a careful history and exam including mother's diet and medications and then elimination diet for the mother as with food protein induced proctocolitis. DR. Boies also recommends counseling about nature course of colic and GERD, such as positioning including prone for period while awake, and less reliance on medications for GERD. The most important thing when treating GERD and colic is ensuring proper growth.

While food protein induced allergy can happen to exclusively breastfed infants, breastfeeding plays an important role in the prevention of allergic diseases(AD). Overall, breastfeeding less than three months is not protect against the development of AD. A 2004 study found that exclusive breastfeeding for at least four months can lower incidence of CMP allergy until 18 months. But a more general long term impact of breastfeeding on food allergies remains to be determined.

KellyMom provides a useful resource for mothers on dairy and other food sensitivities in breastfeeding babies, including how closely mother needs to watch what she eats, recognize possible signs of food allergy from normal baby fussiness, and find out what foods are most likely to be the problem.

This is an original post to SDCBC by To-wen Tseng.

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