Pathophysiology Infant is responding to allergens in moms diet Cows milk protein and soy are most common Sensitization could start in utero Occasionally symptoms are seen day 1 Restricting moms diet during pregnancy currently not recommended Large bowel edema, erosions of mucosa, eosinophilic infiltration of the intestinal lining

BMC gastroenterology :82

Maternal Elimination Diet ABM protocol Start with elimination of cows milk products Most cases will improve in hours No more blood, mucous is gone, stools appear normal If no change at all after 2 weeks, also eliminate soy. If no change, add dairy and soy back into the diet, and eliminate something else. Continue in this way with other allergens. Citrus fruits, eggs, nuts, peanut, wheat, corn, strawberries, chocolate Families need education on how to read food labels to avoid substances of each allergen. Geographic variability in the most common allergens

Severe Cases Consider starting with a strict maternal elimination diet Lamb, pears, squash, rice Once symptoms resolve, add a new allergen once a week Addition of pancreatic enzymes No randomized controlled trials Theoretically breaks down allergens in moms gut before absorption Two Creon 6000 with each meal, one with each snack

Breastfed Babies Receiving Formula Supplementation Change to a soy based formula first. If sx are severe and persistent, change to a hydrolyzed formula, or possibly an amino acid- based formula

Re-introducing Allergens Consider allergy testing if other allergic symptoms such as eczema, allergies, hives, chronic diarrhea If baby otherwise well, OK to reintroduce offending allergens 6-9 mo after initial reaction, or wait until 12 mo old

Other Website Resources Web Links ILCA, Academy of Nutrition and Dietetics Resources for recipes Food allergy information

Future Research Further defining the relationship between these gastropathies Incidence in the population Who is more at risk? Other means of identifying offending antigens Further research on maternal treatment such as pancreatic enzymes

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