Lucy first presented at an allergy centre aged 3 months with chronic diarrhoea and mild to moderate eczema across her body and face. Lucy’s weight was on the 25th centile and she had been formula fed from birth. There was a maternal history of eczema, asthma and hay fever, but no paternal history of allergy.
Lucy’s gastrointestinal symptoms were suggestive of non-IgE-mediated cow’s milk allergy, and she was switched onto an extensively hydrolysed formula (eHF) with proven efficacy (Nutramigen 1) in line with current guidelines for formula fed infants with mild to moderate symptoms.1,2
At age 6 months, Lucy’s diarrhoea had resolved and her eczema had cleared, with only the occasional flare. Because Lucy was weaning, her mother was provided with advice, websites and recipes for dairy-free weaning. In addition, Lucy’s formula was switched to Nutramigen 2, which contains more calcium and other nutrients to match the needs of older babies.
At age 9 months, Lucy’s weight had increased and she was now on the 50th centile. Regular skin prick tests (SPTs) between ages 6 months and 2 years were positive for cow’s milk, suggesting some involvement of IgE-mediated allergy.
At age 2 years 4 months, Lucy accidentally drank a cup of milk without an adverse reaction. An oral challenge was performed in hospital, and continued at home for a week, with no allergic reaction. Consequently, dairy was gradually reintroduced to Lucy’s diet, and by age 3 years Lucy was tolerating all foods.
Jack presented at an allergy centre at age 3 months with severe eczema covering a large area of his body and face. Jack was exclusively breast fed and his weight was between the 25th and 50th centile. His family history included asthma and hay fever in both parents.
Jack’s mother was advised on skin care for eczema, and avoidance of milk and egg as these foods commonly cause allergic reactions in breast-fed infants. She was also given advice on low-allergen weaning, as she wanted to start introducing solid foods in the coming months. At age 6 months, Jack’s mother was successfully avoiding dairy and egg, and his symptoms had improved but not resolved completely. Skin prick tests (SPTs) showed that Jack was sensitised to milk, egg and soya.
Consequently, his mother was advised to exclude soya from her diet as well. She was feeling worn out by the constant effort of managing her diet and Jack’s symptoms, and wanted to introduce a formula feed at bedtime. Given Jack’s multiple food allergies, the amino acid-based formula Nutramigen AA was prescribed.
At age 9 months, Jack’s weight had increased to the 50th centile and he was eating a variety of solid foods, with breast milk and night-time feeds of Nutramigen AA. At age 12 months, his weight was on the 75th centile and he was successfully adhering to his elimination diet.
- Vandenplas 2007