Intolerance to protein hydrolysate infant formulas:: An underrecognized cause of gastrointestinal symptoms in infants☆,☆☆,★
Section snippets
Methods
Twenty-eight infants (13 boys, 15 girls) were enrolled; their ages ranged from 22 to 173 days. All infants were referred for evaluation of suspected formula protein intolerance unresponsive to CHF. Patients were recruited from regional clinics, encompassing a four-state region, within a 6-month period.
Before our evaluation, each patient had dietary intervention prescribed by his or her primary physician to treat the suspected formula protein intolerance. All patients were receiving CHF when
Results
The data on 20 infants was used to describe rectal histologic features of infants who continued to have symptoms while receiving CHF. These 20 included only the infants who failed the CHF challenge (recurrence of symptoms in 3 or 4 days) or continued to have occult blood in their stools while the AAF was being used. Histologic features of these infants could be grouped into the three categories: eosinophilic proctitis ( n = 9), focal eosinophilia ( n = 8), and normal ( n = 3). One in the normal
Discussion
Cow milk protein intolerance is perhaps the most common cause of bloody stools in small infants. Though infectious colitis may cause blood in the stool in small infants, it is rare in this age group in developed countries. Anal fissures or other perianal diseases commonly cause blood in the stool as well, but these are frequently overdiagnosed by the untrained observer. Ulcerative colitis and even Crohn’s disease may occur during the neonatal period, but these presentations are extremely rare.
Acknowledgements
The formula used in this study was donated by Scientific Hospital Supply of North America, Gaithersburg, Md.
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Cited by (150)
When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide
2018, Journal of Allergy and Clinical Immunology: In PracticeFood Protein-Induced Enterocolitis Syndrome
2018, Immunology and Allergy Clinics of North AmericaCitation Excerpt :An extensively hydrolyzed casein formula can be used as well.2,7 Approximately 20% of infants with cow’s milk FPIES will not tolerate this and will need an amino acid formula.15,32,33 It has been recognized that patients with cow’s milk FPIES are also at greater risk of solid food FPIES.
International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology
2017, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Strength of recommendation: Strong; Evidence strength: IIa/IIb; Evidence grade: B] The official guidelines1 recommend a hypoallergenic formula for the treatment of FPIES based on several studies demonstrating that most children tolerated extensively hydrolyzed formula, although there are selected children who exclusively tolerate AAFs.7,8,80-82 AAFs are the only completely nonallergenic formulas and can be effective in patients not responding to extensively hydrolyzed formulas and those with FTT.
Early Nutrition and its Effect on the Development of Allergic Diseases
2017, Early Nutrition and Long-Term Health: Mechanisms, Consequences, and Opportunities
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Supported in part by Scientific Hospital Supply of North America, Gaithersburg, Md.
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Reprint requests: Jon A. Vanderhoof, MD, Department of Pediatrics, 8300 Dodge St., Suite 330, Omaha, NB 68114.
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0022-3476/97/$5.00 + 9/22/84643