eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Protein Intolerance: Follow-up

Author: Agostino Nocerino, MD, PhD, Chief of Pediatric Oncology, Department of Pediatrics, University of Udine, Italy
Coauthor(s): Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Contributor Information and Disclosures

Updated: Aug 25, 2009

Follow-up

Deterrence/Prevention

  • Infants with elevated cord serum IgE and a positive family history of atopy are at risk for the development of atopic disease.
  • In some infants at high risk, exclusive breastfeeding with delayed introduction of solid foods until the infant is aged 6 months may delay or possibly prevent the onset of food allergy.
  • Because small amounts of food antigens ingested by the mother are excreted in breast milk, avoidance of allergenic foods by lactating mothers can be recommended; howevever, randomized, controlled trials of the elimination of food allergens from the diet of mothers during pregnancy and breast-feeding or from the diet during the first year of life have not shown reductions in the risk of IgE-mediated food allergies in children at age 7 years.12 Some studies suggest that infants who are exposed to food allergens early are less likely to have food allergies.13 Guidelines for nutritional interventions to prevent atopic disease have been established by the American Academy of Pediatrics.14
  • Two systematic reviews in Cochrane Database did not find any evidence to support feeding infants with hydrolyzed formula or soy protein formula for the prevention of allergy or protein intolerance.15,16
  • The intestinal microflora interacts with the mucosal immune system, and, in germ-free mice, does not develop a normal oral tolerance. The intestinal flora of children with atopy has been found to differ from that of controls. These observations suggest that the normal flora can play a role in the prevention of food allergies.
  • A potential role for probiotics can be hypothesized. Data are accumulating that are extremely encouraging in this area, even if conflictual results are still reported. Administration of Lactobacillus rhamnosus to pregnant and lactating mothers and their offspring for the first few months of life seems to be safe and was shown to be effective in preventing the development of eczema in 50% of children at high risk for food allergy throughout the first 7 years of life.17

Prognosis

  • Food-induced intolerance is most often a temporary disease. Most children can resume consumption of the offending antigen after 1-4 years of elimination diet.
  • Thirty-nine infants with proven cow’s milk protein intolerance from a cohort of 1,749 newborns from the municipality of Odense in Denmark had a good overall prognosis, with a total recovery of 56% at age 1 year, 77% at age 2 years, 87% at age 3 years, 92% at ages 5 and 10 years, and 97% at age 15 years.2 In children younger than 10 years, 41% developed asthma, and 31% developed rhinoconjunctivitis.
  • In food-induced proctocolitis, symptoms generally clear within several days. However, complete resolution of occult bleeding may take as long as 6 weeks.
  • Infants with IgE-mediated cow’s milk proteins allergy have a higher risk for development of allergy against environmental inhalant allergens.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the diagnosis
  • Use of inappropriate formulas, which might lead to worsening of symptoms
 


More on Protein Intolerance

Overview: Protein Intolerance
Differential Diagnoses & Workup: Protein Intolerance
Treatment & Medication: Protein Intolerance
Follow-up: Protein Intolerance
Multimedia: Protein Intolerance
References
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References

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Further Reading

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Keywords

protein intolerance, food allergy, food-protein intolerance, food protein intolerance, food-protein allergy, cow's milk intolerance, cow's milk allergy, egg intolerance, egg allergy, soy intolerance, soy allergy, cow's milk protein, food allergens, immunoglobulin E–mediated pathogenesis, asthma, gastroenteritis, eosinophilic gastroenteritis, enterocolitis syndrome, cow's milk enteropathy, malabsorption syndrome, growth failure, hypoalbuminemia, proctocolitis syndrome, urticaria, angioedema, pollen allergy, oral allergy syndrome, GI anaphylaxis, esophageal eosinophilia, allergic esophagitis, chronic esophagitis, esophageal strictures, eosinophilic gastritis, celiac disease, protein-losing enteropathy, infantile colic, atopic dermatitis, oral aphthae, pyloric stenosis, bowel edema, bowel obstruction, treatment, diagnosis

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Contributor Information and Disclosures

Author

Agostino Nocerino, MD, PhD, Chief of Pediatric Oncology, Department of Pediatrics, University of Udine, Italy
Agostino Nocerino, MD, PhD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Medical Editor

Chris A Liacouras, MD, Director of Pediatric Endoscopy, Department of Pediatrics, Division of Gastroenterology and Nutrition, Associate Professor, Children's Hospital of Philadelphia and University of Pennsylvania
Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

David A Piccoli, MD, Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine
David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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