Immunology/Intolerances

Question 1

What are the main symptoms of lactose intolerance?

Answer 1

Abdominal pain

Bloating

Flatulence

Diarrhea

Question 2

Milk protein allergy comes in two varieties. What are they?

Answer 2

IgE mediated

&

Non-IgE mediated

Question 3

Milk protein allergy that presents with enterocolitis, including hematochezia, anemia, and growth failure, is which sort of milk protein allergy?

Answer 3

Non-IgE

Question 4

If a child suffers from lactose intolerance due to an acute gastroenteritis episode, what nutritional practice will help to improve the situation?

Answer 4

Early refeeding

Question 5

What percentage of the pediatric population has a true food allergy?

Answer 5

About 2 %

Question 6

What percentage of infants with a food allergy will “outgrow” the allergy by age 3 years?

Answer 6

40 %

Question 7

What are the most common food allergies?

5

Answer 7

1.  Eggs
2.  Nuts
3.  Milk
4.  Wheat
5.  Soy

Question 8

Cow’s milk and soy protein allergy usually cause what type of allergic colitis?

Answer 8

Eosinophilic colitis

or eosinophilic gastroenteropathy

Question 9

Is cow’s milk or soy protein allergy seen in exclusively breast fed infants?

Answer 9

yes

Question 10

What are the signs that go with eosinophilic esophagitis? (3)

Answer 10

1.  GE reflux (often with normal levels of acid production)
2.  Dysphagia
3.  Poor growth

Question 11

How is eosinophilic esophagitis thought to develop?

Answer 11

Via food allergy

IgE or non-IgE

Question 12

Are other sorts of atopic disorders common in patients with eosinophilic esophagitis?

Answer 12

Yes

Question 13

How should the pediatrician manage a suspected food allergy (without anaphylactic reaction)?

(3 steps

Answer 13

1.  Elimination diet (remove suspected food)
2.  Reintroduce the food
3.  Eliminate again to verify response

Question 14

What are the most common food allergies in children?

Answer 14

Cow milk, eggs, and peanuts account for 75% of abnormal food challenges. Soy, wheat, fish, and shellfish are also common allergens.

Question 15

How are adverse food reactions characterized?

Answer 15

• Food allergy: Ingestion of food results in hypersensitivity reactions mediated most commonly by IgE.
• Food intolerance: Ingestion of food results in symptoms not immunologically mediated, and causes may include toxic contaminants (e.g., histamine in scombroid fish poisoning), pharmacologic properties of food (e.g., tyramine in aged cheeses), digestive and absorptive limitations of host (e.g., lactase deficiency), or idiosyncratic reactions.

Question 16

What can be the acute manifestations of milk protein allergy in childhood?

Answer 16

• Angioedema
• Urticaria
• Acute vomiting and diarrhea
• Anaphylactic shock
• Gastrointestinal bleeding

Question 17

What is the most common chronic manifestation of milk protein allergy?

Answer 17

Diarrhea of variable severity. Histologic abnormalities of the small intestinal mucosa have been documented, with the most severe form seen as a flat villous lesion. Protein-losing enteropathy may result from disruption of the surface epithelium. The stools of children with primary milk protein intolerance often contain blood.

Question 18

What likely condition does a birch-allergic child have who develops tongue swelling when eating an apple?

Answer 18

Oral allergy syndrome. In this IgE-mediated condition, allergic children develop pruritus; tingling; and swelling of the lips, palate, and tongue when ingesting certain fresh fruits and vegetables because of cross-reactivity to proteins similar to those in pollen. In this case, birch shares allergens with raw carrots, celery, and apples. Symptoms generally are limited to the mouth but occasionally can progress to anaphylaxis. Most allergens are heat labile, so this patient should be advised to stick to baked apple pie for dessert.

Question 19

What are the symptoms of allergic proctocolitis or milk protein intolerance in an infant?

Answer 19

Infants, usually between birth and 4 months of age, develop frequent, mucus-streaked, bloody stools. Abdominal pain, irritability and vomiting may also be present.

Question 20

Does the diagnosis of allergic proctocolitis in infants usually require endoscopy?

Answer 20

No. The diagnosis is usually made based on clinical history and physical examination without the need for an endoscopy. Infants are usually being fed a milk-based formula. Proctocolitis is treated by removing the offending food antigen (milk or dairy). Switching to a soy-based formula is usually unsuccessful because of protein cross-reactivity, so it is recommended to switch to a partially hydrolyzed protein. If symptoms persist, an amino acid–based formula may be necessary. Breastfeeding mothers must abstain from milk and soy. Sometimes additional foods need to be excluded. It is important to council patients that it may take 3 to 6 weeks to see complete improvement in both clinical symptoms and GI bleeding.