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

BMC gastroenterology 2011 11:82

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

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

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

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 mo old

Other Website Resources

Web LinksILCA, Academy of Nutrition and

DieteticsResources for recipesFood allergy information

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

Check Out www.infantproctocolitis.org