Q:

8/8/2013
14 wks old infant, only on breast milk, blood and mucus in the stools, fussy and gaining weight. Elimination of diary and based on her diet, elimination of various foods have not been helpful. Selected pricks neg. Baby refuses to take bottle. Mother bent upon nursing. I recommended GI evaluation. What else can be done? Thanks.

A:

Thank you for your inquiry.

I am referring your inquiry to Dr. Chuck Siegel who is a pediatric allergist well versed in food allergy. As soon as we hear from Dr. Siegel, we will forward his response to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Charles Siegel. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Charles Siegel:
In response to your question it appears the primary problem is intestinal related. From your note the child is gaining weight appropriately. From an allergy standpoint, Immunolcap RAST to milk and casein would certainly be valuable, and a trial of an elemental formula e.g. EleCare with no other foods added. I'm not sure how to approach this as the child will not take bottle? However, in essence the mother could be put on a very hypoallergenic diet avoiding milk, egg, grains, peanut, tree nuts, fish shellfish and soy so that in theory these would not be passed to the infant. I am more concerned about other GI pathology including protein-induced enterocolitis (include FPIES).

Sicherer S, Food protein-induced enterocolitis syndrome: Case presentations and management lessons. JACI 2001 (1) 149-156. Cases have been reported in breast-fed infants.

Also Leonard SA et al, Ann Allergy Asthma Immunol. 2011 Aug; 107(2):95-101; consider this entity with avoidance therapy as these reviews note. Other colitis symptoms including infectious could be evaluated through stool microbiology examination. GI consultation is most appropriate.

Chuck Siegel

AAAAI - American Academy of Allergy Asthma & Immunology