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Allergies in Children
Foods that account for 90% of allergic reactions in children are cow’s milk protein, eggs, peanut, soy, tree nuts, fish, and wheat. Food allergy can manifest as urticaria/angioedema, anaphylaxis, atopic dermatitis, respiratory symptoms, or a gastrointestinal (GI) disorder. GI allergic manifestations can be classified as immunoglobulin E (IgE) mediated (immediate GI hypersensitivity and oral allergy syndrome); “mixed” GI allergy syndromes (involving some IgE components and some non-IgE or T-cell-mediated allergic GI disorders) include dietary protein enteropathy, protein-induced enterocolitis, and proctitis. All of these conditions share a common denominator: the response of the immune system to a specific protein leading to pathologic inflammatory changes in the GI tract.
This immunological response can elicit symptoms such as diarrhea, projectile vomiting, dysphagia, constipation, or GI blood loss--symptoms consistent with a GI disorder. The detection of food allergies can be accomplished by the use of radioallergosorbent (RAST) testing and skin prick tests in helping to assess the IgE-mediated disorders. Patch tests may help evaluate delayed hypersensitivity reactions. Treatment of GI allergic disorders ranges from strict dietary elimination of offending food(s), use of protein hydrolysates, and use of L-amino acid-based formula when protein hydrolysates fail. Treatment with topical (for eosinophilic esophagitis) or systemic steroids is used if all dietary measures are unsuccessful.
Maternal breast-feeding or the use from birth of hydrolysate formulas (extensive or partial hydrolysates) may be efficacious in the prevention of atopic disease in “high-risk” families (with at least 1 parent or sibling with a history of atopic disease). Cow’s milk protein allergy is the most common food allergy in infants and young children. It is estimated that up to 50% of pediatric cow’s milk allergy is non-IgE-mediated.
Allergic proctocolitis is a benign disorder manifesting with blood-streaked stools in otherwise healthy-appearing infants who are breast or formula-fed. Symptoms resolve within 48-72 hours following elimination of dietary cow’s milk protein. Most infants tolerate cow’s milk by their first birthday. Food protein-induced entrocolitis syndrome presents itself in young formula-fed infants with chronic emesis, diarrhea, and failure to thrive. Reintroduction of cow’s milk protein following a period of avoidance results in profuse, repetitive emesis within 2-3 hours following ingestion; 20% of acute exposures may be associated with hypovolemic shock. Treatment of acute reactions is with vigorous hydration. Most children become tolerant with age; attempts of re-introduction of milk must be done under physician supervision.
Allergic eosinophilic gastroenteritis affects infants as well as older children and adolescents. Abdominal pain, emesis, diarrhea, failure to thrive, or weight loss are the most common symptoms. A subset of patients may develop protein-losing enteropathy. Fifty percent of affected children are atopic and have evidence of food-specific IgE antibody but skin prick tests and serum food-IgE levels correlate with response to elimination diet poorly. Elemental diet based on the amino-acid formula leads to resolutions of gastrointestinal eosinophilic inflammation typically within 6 weeks.
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The information provided in this Web site is not intended to replace consultation with your physician.
Entire contents © 2016 Ulrich O. Ringwald, M.D. Reproduction in whole or in part without
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