Food Allergy in the Breastfed Infant

Kirsi Järvinen-Seppo, MD, PhD

Disclosures

May 13, 2014

When Can Reintroduction Be Tried?

Introduction of cow's milk and soy into the diet of a cow's milk-allergic infant may be attempted after 1 year of age. In a child with an immediate-type reaction, it is recommended to wait until 1 year after the last reaction occurred. In proctocolitis, introduction can be attempted at 1 year, but in FPIES, it is usually recommended to wait until 12-18 months after the last reaction.[29]

Reintroduction should take place under physician supervision in infants with IgE-mediated allergy or FPIES. In case of proctocolitis, the trigger food may be reintroduced at home, if there is no history of an immediate reaction.

The age at introduction of cow's milk or soy in the case of EoE is at the discretion of the clinician taking care of the infant and is often delayed until later. This may be done at home in cases with no evidence of IgE sensitization. To avoid non-IgE-mediated reactions, skin testing should be repeated before food reintroduction, because occasionally non-IgE-mediated reactions could involve an IgE-mediated mechanism.

Back to the Case: Nutrition After 1 Year of Age

An oral feeding test is conducted, and the infant did not tolerate cow's milk.

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