我要和食物过敏死磕到底！
2013-08-14 09:01阅读：
http://www.breastfeedingheadquarters.com/wp-content/uploads/2012/12/MANAGEMENT_OF_ALLERGIC_COLITIS_IN_BREASTFED_INFANTS.pdf
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
