Transcript Infant Proctocolitis Part 2

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 Diet
ABM 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 acidbased 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 Links
ILCA, Academy of Nutrition and
Dietetics
Resources for recipes
Food 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