加载中…我要和食物过敏死磕到底！
(2013-08-14 09:01:55)| 分类： baby |
MANAGEMENT OF ALLERGIC COLITIS IN BREASTFED INFANTS
Though babies cannot be allergic to human proteins, they can
be allergic to the
foreign food antigens that are present in human milk, due to
maternal food
ingestion. This article focuses on allergic colitis (also
known as allergic
proctocolitis) , a Type IV hypersensitivity reaction that can
occur in both infant
formula fed and breastfed infants. It does not cover IgE
mediated allergies where
hives angioedema and anaphylaxis may be possible
symptoms.
Typical symptoms allergic colitis may include fussiness,
excessive watery stools,
stools that are dark (orange, green, brown) when the expected
color would be
yellow, and even blood or mucus in the stool. Occasionally, an
infant will have
skin breakdown in the perianal area (known as erosive
dermatitis) that will not go
away until the offending antigen is taken out of the diet. Up
to half of infants with
allergic colitis may show additional signs of gastroesophageal
reflux (GERD).
Common signs of GERD include discomfort during or after
feedings, body arching
or fussiness when laid flat.
Treatment of allergic colitis consists of a maternal
elimination diet. There are
several dietary approaches. Most mothers eliminate dairy and
soy, because cow
milk and soy foreign antigens in human milk most commonly
cause infant food
allergy symptoms. If a mother does not think that elimination
of both dairy and
soy is feasible, she should start with elimination of cow milk
products first. Some
experts recommend simultaneously eliminating cow meat products
as well.
Once the offending antigen is eliminated from the diet,
parents should be aware
that symptoms will gradually improve, usually starting around
5 days after the
offending agent is eliminated. It may take up to three weeks
for diarrhea and
bloody stools to completely resolve.
If an infant continues to have frequent stools, ask the mother
to check for hidden
soy and dairy products (see table 1). Foods and medications-
especially prenatal
vitamins- should be checked for hidden products (such as
casein, whey and lactose
in the case of cow milk food additives). Mothers should be
informed that lecithin is
a soy-derived food additive. Most of the time, elimination of
hidden ingredients
will result in symptom improvement. Mothers on a dairy and
soy-free diet will
often want to know what they can consume (“what’s left?”).
Table 2 lists foods
that she can eat on a soy and dairy-free diet. If there still
is no improvement,
elimination of nut products would be next, followed by wheat,
and so on. Food
elimination advances every 5 to 7 days, if no noticeable
improvement is noted.
TABLE 1
Cow-based Hidden
Ingredients
Butter
Butter fat
Butter solids
Butter flavor
Buttermilk
Calcium caseinate
Caramel color
Caramel flavoring
Casein
Caseinate
Dried milk
Galactose
Lactalbumin
Lactate
Lactoferrin
Lactoglobulin
Lactose
Milk
Milk fat
Milk protein
Milk solids
Naturlose
Opta Recaldent
Simplesse
Sour cream
Sour milk solids
Tagatose
Whey
Yogurt
Table 2
Breastfeeding moms on a dairy and soy-free diet can eat the
following foods:
All vegetables except for soy. Some super-sensitive babies
may also show a
sensitivity to "cousins" of soy such as peas or peanuts
All fruits
All meats except for beef products
All grains
Eggs-occasionally a baby will show some sensitivity, but the
majority of the time
infants will tolerate this maternal food ingestion
Keep in mind the following:
Be sure to check food labels for evidence of soy or dairy
products every time
Remember to check the hidden ingredient sheet for hidden
dairy products
Hidden soy ingredients can be listed as lecithin or soy
lecithin
Relapses will sometimes occur after moms have dined out or
have consumed
prepared foods from the grocer
Vegetable oils often contain soy and are used in some
prepared foods
Some helpful websites include:
Enjoylifefoods.com
Foodallergynetwork.org
Assuming that the infant improves with maternal elimination of
soy and dairy, the
mother can attempt to add small amounts of either soy or dairy
into her own diet
after about one to two months of restricted diet. Her diet
would need to revert back
to the stricter regimen if, while reintroducing the food
product, her infant again
displays fussiness and adverse stool changes over the next
five days.
If it is difficult to identify the offending agent, some
mothers are willing to place
themselves on a strict elimination diet. This includes either
a rice and turkey or a
rice and lamb diet. She needs to be sure no other additives
are used in preparing
these foods. After strict adherence for 5 days she then adds
one additional food
product that is neither dairy or soy to her diet. Some
examples would include a
specific vegetable, fruit or oatmeal. Then she observes the
infant for symptoms for
5 days. If there is no adverse response, she repeats the same
process of adding a
food every five days while observing the infant for
symptoms.
An alternative to this strict diet is to eliminate all common
offenders and slowly
add them back. This would include eliminating cow products,
soy, citrus fruits,
eggs, nuts, peanuts, wheat, corn, strawberries and chocolate.
One ingredient is
added every 5-7 days
The mother should be on a multivitamin with minerals while on
a restricted diet.
This usually entails finding a product that does not include
hidden additives that
she is trying to avoid. An online search is often helpful. She
should consume
1000mg of calcium a day (many calcium products are not cow
derived but she
should check with the manufacturer).
If signs of GERD are also present, infant positioning and even
ranitidine may be
needed; however, GERD symptoms may improve in some infants a
few weeks
after the problem antigen is eliminated. Some infants may only
need ranitidine for
a month, while for others, treatment until six to twelve
months of age may be
necessary.
Infants will sometimes experience a setback. For instance, a
mother may
unknowingly ingest a food containing the offending antigen
while dining outside
the home. Restaurant personnel may not be entirely aware of
hidden ingredients in
their own products. Prepared foods at the grocer may not be
accurately labeled. For
example, a label for rotisserie chicken might only state that
it is cooked with
vegetable oil, though the oil is partially derived from soy.
Another setback can
occur after solids are introduced. It is important for parents
to check for trace
elements in infant baby food. Most baby food manufacturers
have helpful charts on
their website that will list trace
ingredients.
As with infant formula allergies, most breastfed infants with
food
hypersensitivities will experience resolution of their allergy
between 12 and 18
months of age. The process of introduction of a small amount
of product as a trial
is generally the same.
Allergic colitis does occasionally occur in breastfed infants.
Determined mothers
can successfully modify their diets in order to eliminate
infant symptoms. The
majority of infants will eventually outgrow their food
sensitivity.
©Diana Mayer, MD, IBCLC
喜欢
0
赠金笔