Gastrointestinal Manifestations of Food Allergy

Shereen M. Reda

Disclosures

Pediatr Health. 2009;3(3):217-229. 

In This Article

Treatment

Strict avoidance of the causal food is the only treatment that prevents recurrence of symptoms.[9] This can be achieved by using extensive hydrolyzed formulas or AAFs in young infants and restriction diet in children.[5] Soy-based formulas should not be used as a substitute for cow's milk formula since around 50% of patients with cell-mediated disorders will react to both.[23] In some patients, it is difficult to avoid the causal food either because of lack of compliance to restriction diet or accidental intake of causal food owing to inaccurate food labeling of the ingredients of manufactured food. Advice from an experienced dietitian is essential in order to achieve complete avoidance and prevent nutritional deficiencies.[29] The offending food must not be introduced until full catch-up growth and weight gain is reached and the initial symptoms have disappeared.[5] The central aspect of management is rechallenging in order to determine the occurrence of tolerance.[5,8] In general, rechallenge should not occur before 6 months of elimination. The timing of rechallenge depends on the severity of disease and the initial reaction.[37,39,43] Patients at risk of severe symptoms should be rechallenged under a physician's supervision with emergency medications immediately available.[5]

Avoidance of allergenic food proved to be successful in EE and EG.[22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49] Corticosteroids, especially when used topically (swallowed fluticasone) showed good results in terms of the resolution of symptoms and the significant reduction of the mucosal eosinophils.[54] Montelukast (leukotriene antagonist) has been shown to reduce the need for systemic corticosteroid treatment in some patients with recurrent EG.[55]

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