I just got this from Maryelle Vonlanthen, MD.....

">I just gave a lecture at the area WIC and LLLI conference in Texas about
>allergies in breastfed infants.
>To my knowledge there is no such thing as allergy to breast milk but
>there is allergy to foreign protein in the mothers milk,  cow and soy
>protein being the most common.
>
>First one must decide if this is really allergy: causes for blood in
>stools could be infectious (any bacteria if diarrhea associated,
>Cdifficile if history of antibiotics in months prior to symptoms) or due
>to fissures especially if baby has hard stools.
>There are 2 kinds of allergies: IgE mediated (the same kind you have with
>penicillin) these babies often have other problems than the GI tract such
>as eczema, urticaria, wheezing,and a strong family hx of similar problem
>in one or both parents.  In this case it may be dangerous for the baby to
>take breastmilk because one cannot be sure that all foreign protein are
>gone and when they are gone from the milk. (Lifshit has reported a baby
>with an anaphyllactic reaction to protein in mother's milk).
>
>The other kind is limited to the GI tract, called milk protein
>intolerance or colitis.  Can be more or less severe.  It usually does not
>cause anaphyllaxis like the other one may.
>
>In both cases what I usually do is confirm the diagnosis by doing either
>a proctoscopy (short tube in baby's bottom, no need for sedation) or
>colonoscopy (long tube all the way up the bowel, baby usually asleep) to
>confirm the suspicion:  biopsies will show a special kind of white blood
>cells in the lining of the colon (eosinophils).  I do this before taking
>the baby off the suspected milk.  If positive we then decide based on
>severity of symptoms whether or not the baby would benefit from removal
>of the offending protein either by mom eliminating out of her diet or by
>switching to a kind of formula like this baby is getting until BM can be
>tried again.  The difficulty is to know what is making the baby sick, I
>usually start with common things like milk and soy before eliminating
>anything else.  I dont like elimination to make the diagnosis because you
>can have a mom on rice cakes and water and still never be sure.
>
>The issue of whether to treat cow's milk colitis if the baby has no
>major bleeding or symptoms other than the small streaks is a difficult one
>and not resolved:  to my knowledge the litterature does not say if you
>could harm a baby by not treating a mild case.  I look at it from the
>standpoint of : to make a small streak of blood dissapear, what harm do
>we do by depriving a baby of breastmilk???
>
>Hope this helps you in your quest.!
>
>Always happy to discuss GI stuff,
>Maryelle, Mother of 2 still tandem nursing a 5.5yo and an almost 1yo
Maryelle Vonlanthen MD
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