eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Soy Protein Intolerance: Differential Diagnoses & Workup

Author: 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
Coauthor(s): Agostino Nocerino, MD, PhD, Chief of Pediatric Oncology, Department of Pediatrics, University of Udine, Italy
Contributor Information and Disclosures

Updated: Nov 5, 2009

Differential Diagnoses

Gastroenteritis
Gastroesophageal Reflux
Ulcerative Colitis

Other Problems to Be Considered

GI bleeding
Celiac disease
Malabsorption syndrome
Infectious colitis

Enteropathy

Cow's milk protein intolerance
Autoimmune enteropathy
Intractable diarrhea of infancy
Intestinal infections

Enterocolitis

Intestinal infections
Cow milk protein intolerance
Inflammatory Bowel Disease

Proctocolitis

Anal Fistulas and Fissures
Meckel Diverticulum
Intestinal duplication
Intestinal hemangiomas
Intestinal infections
Cow milk protein intolerance
Inflammatory Bowel Disease

Workup

Other Tests

  • Soy-induced GI symptoms are not usually immunoglobulin E (IgE)-mediated; therefore, both skin tests and determination of specific IgE in serum have a low diagnostic value.
  • Radioallergosorbent assay test (RAST) appears to be of poor predictive value. Many children with positive results do not react to challenge tests.
  • Prick tests have little predictive value. The acidic subunits of glycinin and beta-conglycinin appear to be present in reduced amounts or absent in some commercial soybean skin test extracts tested by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. As a consequence, these commercial extracts are less sensitive than extracts of soy flour.
  • Patch testing may provide more clinical relevant informations, particularly in children with eczema.
  • The challenge test with soy proteins, after an elimination diet, is the only reliable method of evaluating soy protein intolerance.

Procedures

  • Endoscopy: During the workup for differential diagnoses, upper or lower GI endoscopies are often performed in patients with soy protein intolerance. However, findings are nonspecific, most commonly minimal, and, at times, even completely unremarkable. Accordingly, and because of the transient nature of the disorder, endoscopies are not considered essential.
  • Esophagogastroduodenoscopy
    • Macroscopically, only minimal erythematous changes may be observed.
    • Microscopically, any area (eg, lower esophagus, gastric body, antrum, duodenum) may or may not show signs of acute inflammation.
    • In a minority of patients, an infiltrate of eosinophils is observed.
    • When the clinical presentation is that of a malabsorption syndrome, the duodenal mucosa may have changes (eg, partial villous atrophy, crypt hyperplasia) indistinguishable from those of celiac disease.
  • Colonoscopy
    • Macroscopically, changes may vary from minimal erythematous segments, most commonly diffusely involving the distal colon, to severe inflammation with bleeding ulcers and loss of vascular markings.
    • Microscopically, nonspecific acute inflammatory changes are observed, typically indistinguishable from infectious colitis. Rarely, eosinophils predominate in the lamina propria.

More on Soy Protein Intolerance

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

  1. [Guideline] American Academy of Pediatrics Committee on Nutrition. Soy protein-based formulas: recommendations for use in infant feeding. Pediatrics. Jan 1998;101(1 Pt 1):148-53. [Medline].

  2. ESPGHAN Committee on Nutrition. Soy Protein Infant Formulae and Follow-On Formulae: A Commentary by the ESPGHAN Committee on Nutrition. J. Ped. Gastroenterol. Nutr. Apr 2006;42 (4):352-361. [Medline]. [Full Text].

  3. [Best Evidence] Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006;(4):CD003741. [Medline].

  4. Giampietro PG, Ragno V, Daniele S. Soy hypersensitivity in children with food allergy. Ann Allergy. Aug 1992;69(2):143-6. [Medline].

  5. Johnstone DE, Roghmann KJ. Recommendations for soy infant formula: a review of the literature and a survey of pediatric allergists. Pediatr Asthma Allergy Immunol. 1993;7:77-88.

  6. Halpern SR, Sellars WA, Johnson RB, Anderson RB, Saperstein S, Reisch JS. Development of childhood allergy in infants fed breast, soy, or cow milk. Allergy Clin Immunol. 1973;51:139-151.

  7. Bruno G, Giampietro PG, Del Guercio MJ. Soy allergy is not common in atopic children: a multicenter study. Pediatr Allergy Immunol. Nov 1997;8(4):190-3. [Medline].

  8. Sampson HA. Jerome Glaser lectureship. The role of food allergy and mediator release in atopic dermatitis. J Allergy Clin Immunol. Apr 1988;81(4):635-45. [Medline].

  9. Zeiger RS, Sampson HA, Bock SA, et al. Soy allergy in infants and children with IgE-associated cow's milk allergy. J Pediatr. May 1999;134(5):614-22. [Medline].

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

  11. Zoppi G, Guandalini S. The story of soy formula feeding in infants: a road paved with good intentions. J Pediatr Gastroenterol Nutr. May 1999;28(5):541-3. [Medline].

  12. Iyngkaran N, Yadav M, Looi LM. Effect of soy protein on the small bowel mucosa of young infants recovering from acute gastroenteritis. J Pediatr Gastroenterol Nutr. Jan-Feb 1988;7(1):68-75. [Medline].

  13. 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].

  14. Ballmer-Weber BK, Holzhauser T, Scibilia J et al. Clinical characteristics of soybean Clinical characteristics of soybean allergy in Europe: A double-blind, placebo-controlled food challenge study. J Allergy Clin Immunol. Jun 2007;119 (6):1489-96. [Medline]. [Full Text].

  15. Masilamani K, Jolles S, Huddart S, Tuthill DP. Successful dietary treatment of recurrent intussusception. Arch Dis Child. Mar 2009;94(3):248-9. [Medline].

  16. Aggett PJ, Haschke F, Heine W. Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition. Acta Paediatr. Mar 1993;82(3):314-9. [Medline].

  17. American Academy of Pediatrics: Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. Aug 2000;106 (2 Pt1):346-9. [Medline]. [Full Text].

  18. Businco L, Bruno G, Giampietro PG. Soy protein for the prevention and treatment of children with cow-milk allergy. Am J Clin Nutr. Dec 1998;68(6 Suppl):1447S-1452S. [Medline].

  19. Businco L, Dreborg S, Einarsson R, et al. Hydrolysed cow's milk formulae. Allergenicity and use in treatment and prevention. An ESPACI position paper. European Society of Pediatric Allergy and Clinical Immunology. Pediatr Allergy Immunol. Aug 1993;4(3):101-11. [Medline].

  20. Eastham EJ, Lichauco T, Pang K, Walker WA. Antigenicity of infant formulas and the induction of systemic immunological tolerance by oral feeding: cow's milk versus soy milk. J Pediatr Gastroenterol Nutr. 1982;1(1):23-8. [Medline].

  21. Franck P, Moneret Vautrin DA, Dousset B, et al. The allergenicity of soybean-based products is modified by food technologies. Int Arch Allergy Immunol. Jul 2002;128(3):212-9. [Medline].

  22. Halpin TC, Byrne WJ, Ament ME. Colitis, persistent diarrhea, and soy protein intolerance. J Pediatr. Sep 1977;91(3):404-7. [Medline].

  23. Herian AM, Bush RK, Taylor SL. Protein and allergen content of commercial skin test extracts for soybeans. Clin Exp Allergy. Apr 1992;22(4):461-8. [Medline].

  24. Perkkio M, Savilahti E, Kuitunen P. Morphometric and immunohistochemical study of jejunal biopsies from children with intestinal soy allergy. Eur J Pediatr. Sep 1981;137(1):63-9. [Medline].

  25. Poley JR, Klein AW. Scanning electron microscopy of soy protein-induced damage of small bowel mucosa in infants. J Pediatr Gastroenterol Nutr. May 1983;2(2):271-87. [Medline].

  26. Setchell KD. Phytoestrogens: the biochemistry, physiology, and implications for human health of soy isoflavones. Am J Clin Nutr. Dec 1998;68(6 Suppl):1333S-1346S. [Medline].

  27. Setchell KD, Zimmer-Nechemias L, Cai J. Exposure of infants to phyto-oestrogens from soy-based infant formula. Lancet. Jul 5 1997;350(9070):23-7. [Medline].

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Further Reading

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Keywords

soy protein intolerance, soy allergy, soy protein allergy, formula, infant formula, soy-based infant formula, soy-based formula, soy protein formula, SPF, soybeans, soybean components, soy protein allergy

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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.

Medical Editor

Jorge H Vargas, MD, Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, David Geffen School of Medicine, University of California at Los Angeles; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System
Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
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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