COW'S MILK PROTEIN ALLERGY CASE STUDY

Isla was a gorgeous girl, born naturally at term and fully breastfed but a little unsettled with gastrointestinal symptoms. Mum reported that she was “colicky” and reported symptoms such as being fussy/unsettled, with back arching and persistent crying and back arching to the GP. Isla was referred to a paediatrician, who initially thought that she had gastro oesophageal reflux (GOR) and tried multiple treatments. They tried Gaviscon, Ranitidine and thickened breastmilk and infant formulas. None were successful.

The paediatrician referred Isla to a paediatric dietitian who performed an allergy-focused diet history and clinical assessment. The dietitian also asked about a family history of allergies or intolerances and explained the difference between a milk protein allergy and lactose intolerance or other functional gastrointestinal disorders.

It seemed Isla had both immediate and delayed GI symptoms (loose watery stools, wind, vomitin after each feed). Based on the mix of non-IgE and IgE-mediated symptoms, a serum specific IgE test was requested. Working with the allergy clinic, the dietitians mad a diagnosis of Cow’s Milk Protein Allergy. Mum was supported in her choice of breastfeeding, using an infant formula, or a combination of both. Mum chose the latter and she was counselled on how to manage her own diet whilst breastfeeding Isla. Mum did great and it is possible to keep breastfeeding an allergic infant! However, the family chose to have a few formula feeds and Isla was started on an extensively hydrolysed infant specialty formula with pre- and probiotics.

Isla seemed to be doing better, however the dietitian wanted to do a review. Mum reported some loose stools and occasional vomiting. Some infants do not show complete symptom resolution on an extensively-hydrolysed or plant-based formula, although many do. For Isla however, the next step was a prescription for an amino acid-based specialty infant formula. The dietitian advised that it might take up to two weeks for Isla to fully tolerate the formula, but thankfully, after only one week, mum was happy to report that she was doing well! Isla’s stools were formed but soft, and her vomiting had eased. A month on and things kept improving.

The dietitian could then provide mum with evidence-based advice around the safe introduction of foods and how to control Isla’s allergen exposure. The allergy clinic was also involved with food challenges and finally Isla began to thrive on solids.

If you suspect an allergy or would like some advice on a breastfeeding or weaning diet, contact our paediatric dietitian at Alchemy in Motion.