Food Allergy Living Blog Tagged Results

Here at Neocate, we get lots of questions about diapers. I mean lots! Many questions relate to constipation or diarrhea. We’ve posted about constipation in the past, but I thought it would be helpful to pull together our past comments on diarrhea, as well as provide some more medical information on the topic courtesy of the National Institutes of Health, or NIH.

Defining “Diarrhea”

Simply defined, diarrhea is loose, watery stools. It also means having these loose stools three or more times a day. There are more specific guidelines, but most people know diarrhea when they see it. Diarrhea happens to everyone, usually about once a year for adults and twice a year for young children.

Typically, diarrhea is acute, meaning that it lasts one or two days and then goes away. This type of diarrhea is typically caused by an infection. If diarrhea lasts more than two days, it can be something more serious. Diarrhea lasting more than two to four weeks – chronic diarrhea – may be a symptom of a chronic disease or condition.

The concern with diarrhea, especially when it lasts more than two days, is a risk of dehydration. Our bodies absorb most of the water and some minerals at the end of our digestive tract. When we have diarrhea we can’t absorb those things, leading to dehydration, which can be serious.

Diarrhea in Infants

New parents quickly become experts at several things, one of which is changing diapers. Since infants go through about eight diapers a day, parents easily pick up on anything abnormal. Every baby’s stools are different in terms of how watery they are, which makes defining diarrhea in infants difficult. To keep it simple, diarrhea is typically a sudden onset of frequent bowel movements that are more watery than usual.

The risk of dehydration from diarrhea is much higher in children than most adults, and especially in infants. Since infants can’t tell us what they’re feeling, it’s important to keep an eye out for signs of dehydration. With children and infants, you shouldn’t hesitate to call their healthcare provider if you have concerns. For infants under 4 months, the recommendation is that you contact the doctor at the first sign of diarrhea or dehydration.

Diarrhea and Food Allergies

Pulling this all together, diarrhea is one of the top signs of a food allergy, especially for infants. In infants with food allergies, diarrhea often lasts more than just a few days and may even be combined with other symptoms. It’s not uncommon to also see blood or mucus in the stool. Diarrhea can also result from lactose intolerance, which is not as severe as a food allergy, but which may also require a change in diet.

Like we hear from many Neocate parents, diarrhea is often one of the first signs to clear up after they start using Neocate. This is because Neocate doesn’t contain any lactose (or any dairy at all!) or whole proteins. These substances would normally cause a reaction in the body that leads to poor absorption and diarrhea. Infants are able to absorb the nutrients they need from Neocate without the bad reaction that often results in diarrhea. Most parents tell us that the switch to Neocate has meant more solid stools and many fewer diapers.

- Rob

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FPIES, or food protein induced enterocolitis syndrome, is a condition that I’ve been hearing about more and more lately. It is not particularly well-known, so I thought we could cover some of the basics in today’s blog.

What is FPIES?

FPIES is a disease that typically affects infants and young children. While it can mimic food allergies, the difference with FPIES is that it is a non-IgE mediated immune reaction in the gastrointestinal (GI) system to one or more specific foods. This means that the IgE antibodies associated with other food allergies are not involved in an FPIES reaction.

Cow’s milk and soy are the most common FPIES triggers, but ANY foods can cause an FPIES reaction (even ones that aren’t typically considered to be allergens like rice and oats).

Common Symptoms of FPIES

Most FPIES reactions happen when a child is very young – just a few weeks or months old. Often it happens when the first formulas or solid foods are introduced (breastmilk doesn’t usually cause an FPIES reaction, even if the mother has eaten a trigger food).

Each child is different, but the most common symptoms of FPIES involve the GI tract and can include projectile vomiting and diarrhea, which means that it is often mistaken for a stomach bug. There is almost always a delayed onset of symptoms - often vomiting occurs 2 hours after eating a trigger food, with diarrhea following 5 hours after eating. Some children experience relatively mild symptoms, while others have such severe vomiting and diarrhea that they can become seriously dehydrated and go into shock.

Diagnosing and Treating FPIES

It can be difficult to diagnose FPIES because blood allergy tests only look for IgE-mediated responses. Usually a diagnosis occurs after repeated reactions. Keeping a food journal may be helpful in identifying triggers if you think your child has FPIES.

Treating FPIES varies depending on the child, their triggers and reactions. For infants with FPIES an elemental formula like Neocate is often used. For some children who have fewer triggers treatment is simply to avoid those foods. Introducing new foods slowly – one at a time and for up to three weeks – is extremely important to identify both safe and trigger foods. If your child has an FPIES reaction, it is important that they remain hydrated to avoid going into shock.

Outgrowing FPIES

Many children with FPIES outgrow the disease by age three, but this can vary based on how severe their symptoms are and which foods they react to. According to an article from Kids With Food Allergies, one study showed that 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three, while only 40% of those with FPIES to rice, and 60% to dairy tolerated it by the same age.

To determine if your child has outgrown FPIES it is important to work with your doctor and evaluate it on a food-by-food basis. Atopy patch testing can help assess if your child is ready for an oral challenge in your doctor’s office or hospital (do not attempt without a doctor’s supervision!).

We hope this helps shed some light on an often confusing disease. If any of you have children with FPIES and can share your experiences, please leave a comment!

- Sarah