eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Protein Intolerance: Treatment & Medication

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

Treatment

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.

Medication

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.

Corticosteroids

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


Triamcinolone (Aristocort)

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

Adult

Apply thin film to affected area bid/tid until favorable response obtained

Pediatric

Administer as in adults

Documented hypersensitivity; fungal, viral, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria


Hydrocortisone (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.

Adult

Apply sparingly to affected areas bid/qid

Pediatric

Apply as in adults

Documented hypersensitivity; viral, fungal, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use, applying over large surface areas, application of potent steroids, and occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria


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.

Adult

2 inhalations (84 mcg) PO tid/qid; alternatively, 4 inhalations (168 mcg) PO bid
Severe asthma: 12-16 inhalations (504-672 mcg)/d PO; adjust dosage downward to response; not to exceed 20 inhalations (840 mcg)/d PO
1-2 sprays/nostril (42 mcg/spray) qd/bid; titrate to lowest effective dose
Vancenase AQ Double Strength (84 mcg/spray): 1-2 sprays/nostril (84-168 mcg) qd; titrate to lowest effective dose

Pediatric

<6 years: Not established
6-12 years: 1-2 inhalations (42-84 mcg) PO tid/qid to response; alternatively, 4 inhalations (168 mcg) PO bid; not to exceed 10 inhalations (420 mcg)/d PO
6-12 years: Administer intranasally as in adults

Coadministration with ketoconazole may increase plasma levels but does not appear to be clinically significant

Documented hypersensitivity; bronchospasm; status asthmaticus; other types of acute episodes of asthma

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Weight gain, increased bruising, cushingoid features, acneiform lesions, mental disturbances, and cataracts may occur (taper medication slowly if these changes occur)

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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