Milk- and soy-induced enterocolitis of infancy

Clinical features and standardization of challenge
  • Author Footnotes
    1 From the Department of Pediatrics, Division of Gastroenterology, University of Texas Medical Branch.
    Geraldine K. Powell
    Reprint address: Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77550.
    1 From the Department of Pediatrics, Division of Gastroenterology, University of Texas Medical Branch.
    Galveston, Texas, USA
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  • Author Footnotes
    1 From the Department of Pediatrics, Division of Gastroenterology, University of Texas Medical Branch.
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      A diagnosis of gastrointestinal food allergy was suspected in nine infants who had protracted diarrhea of infancy. To delineate a consistent response to antigen challenge that would be characteristic for this category of infants with gastrointestinal allergy, stools were evaluated for the presence of blood, leukocytes, and carbohydrate before and after a challenge feeding. Each infant received two separate single challenges of cow milk and soy, respectively (total 18 challenges). A positive response was seen in 14 of the challenges, consisting of diarrhea with fecal blood and leukocytes, occurring within 12 hours. Vomiting (eight of 14) and transient carbohydrate malabsorption (ten of 14) were frequently associated with positive responses to challenges. A slight increase in the serum level of βIC globulin and a peripheral polymorphonuclear leukocytosis were seen following challenge in all infants who had a positive response. Eleven additional infants with chronic diarrhea not due to cow milk or soy allergy had negative gastrointestinal responses to challenges with cow milk or soy and did not develop the polymorphonuclear leukocytosis post challenge. All of the infants (controls or patients with gastrointestinal allergy) who failed to meet the criteria proposed for a positive response to a single acute challenge of formula, also tolerated the formula of challenge on a long-term basis.
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