Protein Intolerance Medication

  • Author: Agostino Nocerino, MD, PhD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Apr 12, 2010
 

Medication Summary

Topical or orally and intranasally inhaled corticosteroids are used to treat dermatologic or respiratory symptoms associated with protein intolerance. Antihistamines and inhaled bronchodilatators are used as appropriate for mild cases of immediate hypersensitivity. In severe anaphylactic reactions, intramuscular epinephrine can be life-saving.

Next

Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

View full drug information

Triamcinolone topical (Aristocort)

 

Treats inflammatory dermatosis responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

View full drug information

Hydrocortisone topical (Cortaid, Dermacort, Westcort, CortaGel)

 

Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.

View full drug information

Beclomethasone (Vancenase, Vanceril, Beconase, Beclovent)

 

Inhibits bronchoconstriction mechanisms. Produces direct smooth muscle relaxation. May decrease number and activity of inflammatory cells, in turn decreasing airway hyperresponsiveness and inflammation.

Previous
Proceed to Follow-up
 
 
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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York 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: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, 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.

References

  1. Yu LC. The epithelial gatekeeper against food allergy. Pediatr Neonatol. Dec 2009;50(6):247-54. [Medline].

  2. Hong X, Tsai HJ, Wang X. Genetics of food allergy. Curr Opin Pediatr. Dec 2009;21(6):770-6. [Medline].

  3. Sironi M, Clerici M. The hygiene hypothesis: An evolutionary perspective. Microbes Infect. Feb 21 2010;[Medline].

  4. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. Oct 2008;(10):1-8. [Medline].

  5. Assa'ad A. Eosinophilic gastrointestinal disorders. Allergy Asthma Proc. Jan-Feb 2009;30(1):17-22. [Medline].

  6. Hill DJ, Hosking CS, Heine RG. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Ann Med. Aug 1999;31(4):272-81. [Medline].

  7. Wong GW, Mahesh PA, Ogorodova L, et al. The EuroPrevall-INCO surveys on the prevalence of food allergies in children from China, India and Russia: the study methodology. Allergy. Nov 4 2009;[Medline].

  8. Colver AF, Nevantaus H, Macdougall CF, Cant AJ. Severe food-allergic reactions in children across the UK and Ireland, 1998-2000. Acta Paediatr. Jun 2005;94(6):689-95. [Medline].

  9. [Best Evidence] Kvenshagen B, Jacobsen M, Halvorsen R. Atopic dermatitis in premature and term children. Arch Dis Child. Mar 2009;94(3):202-5. [Medline].

  10. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. Feb 2010;125(2 Suppl 2):S116-25. [Medline].

  11. Aceves SS, Newbury RO, Dohil MA, Bastian JF, Dohil R. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation. Ann Allergy Asthma Immunol. Nov 2009;103(5):401-6. [Medline].

  12. Binkovitz LA, Lorenz EA, Di Lorenzo C, Kahwash S. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation. Pediatr Radiol. May 2010;40(5):714-9. [Medline].

  13. Ozdemir O, Mete E, Catal F, Ozol D. Food intolerances and eosinophilic esophagitis in childhood. Dig Dis Sci. Jan 2009;54(1):8-14. [Medline].

  14. Rothenberg ME, Spergel JM, Sherrill JD, Annaiah K, Martin LJ, Cianferoni A. Common variants at 5q22 associate with pediatric eosinophilic esophagitis. Nat Genet. Apr 2010;42(4):289-91. [Medline].

  15. Mehr SS, Kakakios AM, Kemp AS. Rice: a common and severe cause of food protein-induced enterocolitis syndrome. Arch Dis Child. Mar 2009;94(3):220-3. [Medline].

  16. Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. Aug 2006;17(5):351-5. [Medline].

  17. Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. Jan 2005;115(1):149-56. [Medline].

  18. Hwang JB, Song JY, Kang YN, et al. The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical cow's milk protein-induced enterocolitis. J Korean Med Sci. Apr 2008;23(2):251-5. [Medline].

  19. Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. Jun 2009;94(6):425-8. [Medline].

  20. Behjati S, Zilbauer M, Heuschkel R, et al. Defining eosinophilic colitis in children: insights from a retrospective case series. J Pediatr Gastroenterol Nutr. Aug 2009;49(2):208-15. [Medline].

  21. Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13 Suppl 15:23-8. [Medline].

  22. Kokkonen J, Tikkanen S, Karttunen TJ, Savilahti E. A similar high level of immunoglobulin A and immunoglobulin G class milk antibodies and increment of local lymphoid tissue on the duodenal mucosa in subjects with cow's milk allergy and recurrent abdominal pains. Pediatr Allergy Immunol. Apr 2002;13(2):129-36. [Medline].

  23. Walker WA. Cow's milk protein-sensitive enteropathy at school age: a new entity or a spectrum of mucosal immune responses with age. J Pediatr. Dec 2001;139(6):765-6. [Medline].

  24. Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. Oct 15 1998;339(16):1100-4. [Medline].

  25. [Guideline] Plaut M, Sawyer RT, Fenton MJ. Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. J Allergy Clin Immunol. Oct 2009;124(4):671-8.e1. [Medline].

  26. Frew AJ. Sublingual immunotherapy. N Engl J Med. May 22 2008;358(21):2259-64. [Medline].

  27. Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy. Nov 2007;62(11):1261-9. [Medline].

  28. Wang J, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Allergy Asthma Immunol Res. Oct 2009;1(1):19-29. [Medline].

  29. Lack G. Clinical practice. Food allergy. N Engl J Med. Sep 18 2008;359(12):1252-60. [Medline].

  30. Kull I, Bergstrom A, Lilja G, Pershagen G, Wickman M. Fish consumption during the first year of life and development of allergic diseases during childhood. Allergy. Aug 2006;61(8):1009-15. [Medline].

  31. [Guideline] Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. Jan 2008;121(1):183-91. [Medline].

  32. Iacono G, Di Prima L, D'Amico D, Scalici C, Geraci G, Carroccio A. The "red umbilicus": a diagnostic sign of cow's milk protein intolerance. J Pediatr Gastroenterol Nutr. May 2006;42(5):531-4. [Medline].

  33. Foucard T, Malmheden Yman I. A study on severe food reactions in Sweden--is soy protein an underestimated cause of food anaphylaxis?. Allergy. Mar 1999;54(3):261-5. [Medline].

  34. AAP. Food allergy. In: Kleinman RE, ed. Pediatric Nutrition Handbook. 5th ed. Elk Grove, IL: American Academy of Pediatrics; 2004:593-607.

  35. Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. Jan 2008;121(1):e44-52. [Medline].

  36. Nwaru BI, Erkkola M, Ahonen S, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics. Jan 2010;125(1):50-9. [Medline].

  37. [Guideline] Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. Jan 2008;121(1):183-91. [Medline].

  38. [Best Evidence] Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. Oct 18 2006;CD003741. [Medline].

  39. [Guideline] Allen KJ, Davidson GP, Day AS, et al. Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health. Sep 2009;45(9):481-6. [Medline].

  40. Axelsson I, Jakobsson I, Lindberg T, Benediktsson B. Bovine beta-lactoglobulin in the human milk. A longitudinal study during the whole lactation period. Acta Paediatr Scand. Sep 1986;75(5):702-7. [Medline].

  41. Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol. Jan 1986;39(1):1-7. [Medline].

  42. Bock SA. Evaluation of IgE-mediated food hypersensitivities. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S20-7. [Medline].

  43. [Guideline] Caffarelli C, Baldi F, Bendandi B, et al. Cow's milk protein allergy in children: a practical guide. Ital J Pediatr. Jan 15 2010;36(1):5. [Medline].

  44. Carroccio A, Montalto G, Custro N, et al. Evidence of very delayed clinical reactions to cow's milk in cow's milk-intolerant patients. Allergy. Jun 2000;55(6):574-9. [Medline].

  45. [Guideline] Darsow U, Wollenberg A, Simon D, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol. Aug 31 2009;[Medline].

  46. Dupont C, Heyman M. Food protein-induced enterocolitis syndrome: laboratory perspectives. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S50-7. [Medline].

  47. [Guideline] Ebisawa M. Management of food allergy in Japan "food allergy management guideline 2008 (revision from 2005)" and "guidelines for the treatment of allergic diseases in schools". Allergol Int. Dec 2009;58(4):475-83. [Medline].

  48. [Guideline] Garcia BE, Gamboa PM, Asturias JA, et al. Guidelines on the clinical usefulness of determination of specific immunoglobulin E to foods. J Investig Allergol Clin Immunol. 2009;19(6):423-32. [Medline].

  49. Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr. Aug 1986;109(2):270-6. [Medline].

  50. Hill DJ, Heine RG, Cameron DJ, Francis DE, Bines JE. The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance. J Pediatr. Jul 1999;135(1):118-21. [Medline].

  51. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. Apr 2007;119(4):1019-21. [Medline].

  52. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S28-35. [Medline].

  53. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. Nov 1995;109(5):1503-12. [Medline].

  54. Kokkonen J, Haapalahti M, Laurila K, Karttunen TJ, Maki M. Cow's milk protein-sensitive enteropathy at school age. J Pediatr. Dec 2001;139(6):797-803. [Medline].

  55. Kokkonen J, Karttunen TJ, Niinimäki A. Lymphonodular hyperplasia as a sign of food allergy in children. J Pediatr Gastroenterol Nutr. Jul 1999;29(1):57-62. [Medline].

  56. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. Jan 2007;119(1):192-8. [Medline].

  57. Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S58-60. [Medline].

  58. Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. Dec 1982;101(6):906-10. [Medline].

  59. Leung AK. Food allergy: a clinical approach. Adv Pediatr. 1998;45:145-77. [Medline].

  60. Liacouras CA, Ruchelli E. Eosinophilic esophagitis. Curr Opin Pediatr. Oct 2004;16(5):560-6. [Medline].

  61. Lindberg T. Infantile colic: aetiology and prognosis. Acta Paediatr. Jan 2000;89(1):1-2. [Medline].

  62. Lowichik A, Weinberg AG. A quantitative evaluation of mucosal eosinophils in the pediatric gastrointestinal tract. Mod Pathol. Feb 1996;9(2):110-4. [Medline].

  63. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. Mar 2009;123(3):e459-64. [Medline].

  64. Murch S. Food allergies. In: Guandalini S. Ed. Textbook of pediatric gastroenterology and nutrition. London: Taylor & Francis; 2004.

  65. Niggemann B, Beyer K. Pitfalls in double-blind, placebo-controlled oral food challenges. Allergy. Jul 2007;62(7):729-32. [Medline].

  66. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. Aug 26 2004;351(9):940-1. [Medline].

  67. Novembre E, Vierucci A. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy. 2001;56 Suppl 67:105-8. [Medline].

  68. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2003;CD003664. [Medline].

  69. [Guideline] Plaut M, Sawyer RT, Fenton MJ. Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. J Allergy Clin Immunol. Oct 2009;124(4):671-8.e1. [Medline].

  70. [Guideline] Rance F, Deschildre A, Villard-Truc F, et al. Oral food challenge in children: an expert review. Eur Ann Allergy Clin Immunol. Apr 2009;41(2):35-49. [Medline].

  71. Sampson HA, Anderson JA. Summary and recommendations: Classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S87-94. [Medline].

  72. Sicherer SH. Food protein-induced enterocolitis syndrome: clinical perspectives. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S45-9. [Medline].

  73. Szajewska H, Setty M, Mrukowicz J, Guandalini S. Probiotics in gastrointestinal diseases in children: hard and not-so-hard evidence of efficacy. J Pediatr Gastroenterol Nutr. May 2006;42(5):454-75. [Medline].

  74. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. Jan 2007;119(1):184-91. [Medline].

  75. Tlaskalova-Hogenova H, Tuckova L, Lodinova-Zadnikova R, et al. Mucosal immunity: its role in defense and allergy. Int Arch Allergy Immunol. Jun 2002;128(2):77-89. [Medline].

 
Previous
Next
 
Typical atopic dermatitis on the face of an infant.
Table. Classification of Main Adverse Reactions to Food
Type of Reaction Pathogenesis Clinical Entities
Non–immune-mediatedDisorders of digestive-absorptive processesGlucose-galactose malabsorption, lactase deficiency, sucrase-isomaltase deficiency, enterokinase deficiency
Pharmacological reactionsTyramine in aged cheeses, histamine (eg, in strawberries, caffeine)
Idiosyncratic reactionsFood additives, food colorants
Inborn errors of metabolismPhenylketonuria, hereditary fructose intolerance, tyrosinemia, galactosemia, lysinuric protein intolerance
Immune-mediated (food allergy)IgE-mediated (positive radioallergosorbent test or skin prick test results)Oral allergy syndrome, immediate GI hypersensitivity
Occasionally IgE-mediatedEosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis
Non–IgE-mediatedFood protein–induced entities, such as enterocolitis, enteropathy, proctocolitis, chronic constipation
AutoimmuneInnate and adaptive immunityCeliac disease
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.