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Protein Intolerance Treatment & Management

  • Author: Agostino Nocerino, MD, PhD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Aug 01, 2014
 

Medical Care

The definitive treatment of food protein intolerance is strict elimination of the offending food from the diet.

  • Breastfeeding is the first choice in infants without lactose intolerance. The mother should eliminate cow's milk (and eventually eggs and fish or other implicated foods) from her diet.
  • As many as 50% of children affected by cow's milk protein intolerance develop soy protein intolerance if they are fed with soy-based formulas. Therefore, soy-based formulas should not be used for the treatment of cow's milk protein intolerance. Use complete milk protein hydrolysates in infants who cannot be breastfed. Partially hydrolyzed formulas are absolutely not indicated in children with cow's milk protein intolerance. Occasionally, children may develop intolerance toward complete hydrolysated formulas. In these cases, use amino acid–based formulas, which are now widely available and are balanced in trace elements and vitamins.
  • Eosinophilic gastroenteritis can show clinical and histologic improvement after oral corticosteroid therapy. Topical steroids, administered as inhaled corticosteroids, have also shown beneficial effect.
  • In February 2011, the Journal of Allergy and Clinical Immunology published updated consensus recommendations for eosinophilic esophagitis in children and adults.[35] According to this review, treatment involves dietary therapy of 3 possible regimens: strict use of amino acid–based formula, dietary restriction based on allergy testing, or dietary restriction based on eliminating the most likely food antigens. The committee also recommended that topical steroids should be considered for both initial and maintenance therapy. Treatment with cromolyn sodium, leukotriene receptor antagonists, and immunosuppressive agents was not recommended.
  • Administration of food allergens as immunotherapy carries a greater risk of adverse and potentially severe allergic reactions compared with the administration of inhalant allergens.[36, 37] Based largely on the clinical experience published in European trials, the general impression is that food allergen exposure through the oral or sublingual routes is less risky than through the subcutaneous route, but this perception has yet to be definitively demonstrated.
  • Recombinant monoclonal humanized anti-immunoglobulin E (IgE) therapy has been approved for the treatment of asthma with associated environmental allergies, but the response can vary with food allergies.
  • A 9-herb formula based on traditional Chinese medicine is currently under investigation as a treatment for food allergy.[38]
 
 
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, Italian Society of Pediatric Hematology and Oncology, Italian Society of Pediatric Emergency and Urgent Care Medicine, Italian Society of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Stefano Guandalini, MD Founder and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

Specialty Editor Board

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, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Chris A Liacouras, MD Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

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Typical atopic dermatitis on the face of an infant.
 
 
 
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