Food Sensitivity in Infants

Question 1

What is sensitization?

Answer 1

initial exposure to allergen with subsequent exposure inducing stronger response

Question 2

What are the Clinical Manifestations of Food Hypersensitivity?

Answer 2

• Systemic — Anaphylactic, growth failure
• GI — Abdominal pain, vomiting, cramping, diarrhea
• Respiratory — Cough, wheezing, rhinitis, infiltrates
• Cutaneous — Urticaria, rash, atopic dermatitis

Question 3

What causes food allergies and what are the most common allergens?

Answer 3

• Food allergies caused by allergen, inducing IgE antibody formation (sensitization)
• Most common allergens are: eggs, cow’s milk, and peanuts

Question 4

How would you manage an infant with a serious food allergy?

Answer 4

• Onset 5-30 mins after ingestion
• For children who have risk of anaphylaxis from food allergies (rapid onset of airway difficulties) these are the list of interventions:

1. EpiPen
2. Liquid diphenhydramine
3. MedicAlert bracelet
4. Written emergency plan
5. Caution for biphasic response: immediate response, apparent recovery, acute recurrence of symptoms

Question 5

How would you diagnose a cow’s milk allergy and what are some alternate types of formulas?

Answer 5

• Definitive diagnosis: elimination of milk then 2 or more challenge tests after symptoms improve
• Change infant formula to casein hydrolysate milk formula (Pregestimil, Nutramigen, Alimentum) or
• Soy formula: caution: ~ 50% sensitive to cow’s milk protein and sensitive to soy

Question 6

What are some characteristics of primary lactase deficiency?

Answer 6

• It is the most common lactase deficiency
• Often occurs in children 4-5 years old; Asians, AA
• Lactose malabsorption: Imbalance between ability of lactase to hydrolyze the lactose and the amount of lactose ingested

Question 7

What are some characteristics of secondary lactose deficiency?

Answer 7

• Secondary to damage of intestinal lumen -> destroys or decreases lactase
• Can be caused by: CF, celiac disease, kwashiorkor, infections, HIV, rotovirus

Question 8

How would you treat infants with lactose intolerance?

Answer 8

• Elimination of dairy
• ↓ amount of dairy ingested: prevent reduced bone mass density and subsequent osteoporosis
• Take small amounts if able to tolerate; drink milk with other foods; pre-treated milk with microbial-derived lactase; yogurt, hard cheeses, lactase tablets taken with dairy