Soy Protein Intolerance Workup
- Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD more...
See the list below:
- 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 role of atopy patch test in children with food allergies (including to soy) presenting with constipation has also been suggested.
- The challenge test with soy proteins, after an elimination diet, is the only reliable method of evaluating soy protein intolerance.
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.
See the list below:
- 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.
See the list below:
- 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.
Vandenplas Y, Castrellon PG, Rivas R, Gutiérrez CJ, Garcia LD, Jimenez JE, et al. Safety of soya-based infant formulas in children. Br J Nutr. 2014 Apr 28. 111 (8):1340-60. [Medline].
Mäkinen OE, Wanhalinna V, Zannini E, Arendt EK. Foods for Special Dietary Needs: Non-Dairy Plant Based Milk Substitutes and Fermented Dairy Type Products. Crit Rev Food Sci Nutr. 2015 Jan 9. [Medline].
[Guideline] American Academy of Pediatrics Committee on Nutrition. Soy protein-based formulas: recommendations for use in infant feeding. Pediatrics. 1998 Jan. 101(1 Pt 1):148-53. [Medline].
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].
Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006. (4):CD003741. [Medline].
Giampietro PG, Ragno V, Daniele S. Soy hypersensitivity in children with food allergy. Ann Allergy. 1992 Aug. 69(2):143-6. [Medline].
Andres A, Cleves MA, Bellando JB, Pivik RT, Casey PH, Badger TM. Developmental status of 1-year-old infants fed breast milk, cow's milk formula, or soy formula. Pediatrics. 2012 Jun. 129(6):1134-40. [Medline].
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.
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.
Bruno G, Giampietro PG, Del Guercio MJ. Soy allergy is not common in atopic children: a multicenter study. Pediatr Allergy Immunol. 1997 Nov. 8(4):190-3. [Medline].
Sampson HA. Jerome Glaser lectureship. The role of food allergy and mediator release in atopic dermatitis. J Allergy Clin Immunol. 1988 Apr. 81(4):635-45. [Medline].
Zeiger RS, Sampson HA, Bock SA, et al. Soy allergy in infants and children with IgE-associated cow's milk allergy. J Pediatr. 1999 May. 134(5):614-22. [Medline].
Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009 Mar. 123(3):e459-64. [Medline].
Zoppi G, Guandalini S. The story of soy formula feeding in infants: a road paved with good intentions. J Pediatr Gastroenterol Nutr. 1999 May. 28(5):541-3. [Medline].
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. 1988 Jan-Feb. 7(1):68-75. [Medline].
Foucard T, Malmheden Yman I. A study on severe food reactions in Sweden--is soy protein an underestimated cause of food anaphylaxis?. Allergy. 1999 Mar. 54(3):261-5. [Medline].
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].
Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow's milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011 Mar. 127(3):647-53.e1-3. [Medline].
Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T, et al. Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. BMC Gastroenterol. 2011 Jul 16. 11(1):82. [Medline].
Masilamani K, Jolles S, Huddart S, Tuthill DP. Successful dietary treatment of recurrent intussusception. Arch Dis Child. 2009 Mar. 94(3):248-9. [Medline].
Syrigou EI, Pitsios C, Panagiotou I, Chouliaras G, Kitsiou S, Kanariou M, et al. Food allergy-related paediatric constipation: the usefulness of atopy patch test. Eur J Pediatr. 2011 Feb 25. [Medline].
Duenas-Laita A, Pineda F, Armentia A. Hypersensitivity to generic drugs with soybean oil. N Engl J Med. 2009 Sep 24. 361(13):1317-8. [Medline].
Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010 Mar. 125(3):683-6. [Medline].
Aggett PJ, Haschke F, Heine W. Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition. Acta Paediatr. 1993 Mar. 82(3):314-9. [Medline].
Businco L, Bruno G, Giampietro PG. Soy protein for the prevention and treatment of children with cow-milk allergy. Am J Clin Nutr. 1998 Dec. 68(6 Suppl):1447S-1452S. [Medline].
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. 1993 Aug. 4(3):101-11. [Medline].
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].
Franck P, Moneret Vautrin DA, Dousset B, et al. The allergenicity of soybean-based products is modified by food technologies. Int Arch Allergy Immunol. 2002 Jul. 128(3):212-9. [Medline].
Halpin TC, Byrne WJ, Ament ME. Colitis, persistent diarrhea, and soy protein intolerance. J Pediatr. 1977 Sep. 91(3):404-7. [Medline].
Herian AM, Bush RK, Taylor SL. Protein and allergen content of commercial skin test extracts for soybeans. Clin Exp Allergy. 1992 Apr. 22(4):461-8. [Medline].
Perkkio M, Savilahti E, Kuitunen P. Morphometric and immunohistochemical study of jejunal biopsies from children with intestinal soy allergy. Eur J Pediatr. 1981 Sep. 137(1):63-9. [Medline].
Poley JR, Klein AW. Scanning electron microscopy of soy protein-induced damage of small bowel mucosa in infants. J Pediatr Gastroenterol Nutr. 1983 May. 2(2):271-87. [Medline].
Setchell KD. Phytoestrogens: the biochemistry, physiology, and implications for human health of soy isoflavones. Am J Clin Nutr. 1998 Dec. 68(6 Suppl):1333S-1346S. [Medline].
Setchell KD, Zimmer-Nechemias L, Cai J. Exposure of infants to phyto-oestrogens from soy-based infant formula. Lancet. 1997 Jul 5. 350(9070):23-7. [Medline].