Infants and Toddlers have a much more permeable GI tract and are very susceptible to food allergies. These can be difficult and can be mediated through both IgE and IgG. They can result in terrible GI symptoms of vomiting, diarrhea, bloating and colic. They can also result in skin symptoms such as atopic dermatitis and eczema or upper respiratory tract symptoms such as nasal congestion, ear and sinus infections. They lead to many sleepless nights for both the child and parents.
The diagnosis is made primarily by taking a history. Your physician needs to be educated and aware food allergies. Unfortunately the allergy skin and blood tests are not very sensitive for IgG mediate (or cyclic) food allergies. A food diary for the child or nursing mother is paramount. IgG testing has not been proven helpful. It has often been called a very expensive means to a food diary. IgE blood testing and skin testing can be helpful and we do typically perform them here at Midwest ENT. Eosinophilic esophagitis is a new and disturbing end point for allergies affecting the gastrointestinal tract.
Treatment is primary dietary manipulation. We encourage mothers to continue nursing and actually monitor their own diet as many antigenic proteins pass through the breast milk. Casein and Whey are the primary antigenic proteins in Cow’s milk, and dairy is the biggest culprit. In children that are not nursing we often will try a hypoallergenic formula. Our favorites include Elecare, Neocate, and Neutramogen. They can be quite expensive and Neutramogen smells funny. I recommend buying them on E-Bay. EO28 Splash is another excellent option. Goats milk is a good alternative for some, Soy milk is excellent if they are not Soy allergic. Rice milk is also a good option.
Desensitization is controversial, however, we do now offer the LaCrosse protocol for our patients. This has proven extremely helpful for many of our patients and represents an exciting break through. The good news is that, with the exception of fixed food allergies (such as those to peanut), most children will outgrow these sensitivities. As the intestinal tract matures fewer proteins can cross and more foods will be tolerated. We can help you work through these trying times and offer you any and all possible treatments.