January Week 2: Mild Protein Allergy/Lactose Intolerance

Baral V, et al. Food Allergy in Children. PMJ, 2005; 81:693-701.

Case 1:

You are seeing a 2 yo male with severe atopic dermatitis. Mom has tried emollients and topical steroids with no improvement. She has been reading about elimination diets and asks for your advice about what to do next.

If this patient does have food allergies, what type of allergy is it likely to be, ie IgE vs non-IgE mediated? 
What are the most common foods that children are allergic to? 
Which food allergies are kids most likely to “grow out of”? 
What are your next steps in diagnosing and treating this child?

Case 2:

A 10 mo old girl is brought in by mom and dad after 3 days of vomiting and diarrhea. The vomiting began first and has now resolved, but parents report she is still having 2-3 stools every hour. They thought the diarrhea was improving yesterday so they switched back to her formula after having given her pedialyte for a couple of days. However they brought her in today because the diarrhea has worsened.

What is this patient’s diagnosis? 
What do you recommend to the parents for treatment?

Case 3:

Parents bring their 3 week old son to your office because they found flecks of blood in his diaper this morning. He has been feeding well, breastfeeding exclusively, every 2-3 hours. Birth weight was 3.35 kg, today’s weight is 3.28 kg. Parents do not note any vomiting, discomfort during feeds, abdominal distention, lethargy. He has been otherwise acting normally, no excessive crying, normal activity and wet diapers.

What do you think is going on? 
What do you advise the parents?