Karen,

I read your post regarding the babe with projectile vomiting after
feeds with great interest.  I found myself in a similar circumstance
with my oldest daughter when she was an infant.  She had projectile
vomiting, followed by bloody diarrhea.  After months of testing and
frustration during which I was told to stop breast feeding and try
each of the three most common protein hydrolosate formulas, we finally
isolated numerous IGE mediated allergies.  She is allergic to dairy,
beef, egg, wheat, and peanuts.  While I had removed dairy from my
diet, I had not looked for other allergens; hence the symptoms
continued. I found that the symptoms were present immediately and for
the 2-3 days after I ate the offending food.

I need to make 5 points that may benefit you in assisting this mother.

1.  Dairy is tough to eliminate.  Teach her to read labels of
everything for it is everywhere.  Look for not only casein and whey,
but caseinate, lactalbumin, curds, yogurt, butter,artificial butter
flavor, rennet, carmel, and lactose.  The letter U circled followed by
Parve on a label is a reliable dairy free indicator.  Nice
substitutions for dairy are Rice Dream frozen and liquid products.
Fleishman's No Salt Margarine (green box) is also completely dairy
free and relatively good to cook with.  These are also pretty easiy to
find in regular grocery stores.

2. Consider other allergens. The most common allergens are:  wheat,
egg, peanut, corn, and citrus.   If the babe reacted to Soy formula, I
would be particularlly interested in Soy and Peanuts in the mom's
diet.  While she may not be eating much Tofu, many "modified food
starches" or "food protein" is in fact soy.  Hence many prepared
foods...  An allergy to Soy does not necessarily translate to an
allergy to peanuts, but there are chemical similarities.  And peanut
is a very common, very potent allergen.  Is this mom eating the quick
and easy peanut butter sandwich for lunch?  Would she have to avoid
the soy and peanut oils?  Technically, not.  The oils are supposedly
protein free.  However, "pressed oil technology" does allow some nut
meat to pass through and thus there is protein present.  Use with
great caution and again read labels.  An article in _everyone's
favorite newspaper_ the Wall Street Journal on 8-14-95 discussed the
increasing prevelance of peanut use in food juxtaposed with its
seeming increased presence as an allergen in the population.  They
noted that peanut butter is even used as a sealler in the wrapping of
some egg rolls!

3.  Use a food/symptom diary and a two week diet plan to test this
baby's response.   _Have mom eliminate common allergens for her diet
for two weeks._  If this is allergy related, babe should be GI symptom
free by then. (Excema would take longer than 2 weeks)  Gradually add
in allergens: one per 3-4 day period with increasing dose over that
time period so that on day four she is eating alot of the offending
substance.  If no reaction, no allergy.  If the baby does react to
minimal ammounts, avoid it altogether.  If it takes 10 glasses of milk
to get a reaction, then maybe she can get away with a piece of cheese
now and then.

4.  This is an issue of informed consent.  There is no _perfect_ abm
out here for babes with allergy.  The protein hydrolosate formulas
have been shown to contain whole protein chains.  BREAST MILK IS
ABSOLUTELY BEST, but must be free from allergens.  People who think
that the symptoms are not bad enough to warrent exclusion from the
diet may be in for a rude awakening later in the form of illness, i.e.
childhood asthma.  Patients with gluten sensitivity (Celiac disease)
who are not compliant with a gluten free diet have a much higher than
normal risk of GI tract cancers and lymphoma's.  Allergy is a
equivalent to the body receiving friendly fire injury.  Just how much
injury can it sustain, before it wants to pull out of the fight?

5.  There is much quackery out there regarding food allergies.  I
recommend a great textbook which presents a balanced, research based
approach to dealing with this vexing problem.  The text is FOOD
ALLERGY; ADVERSE REACTIONS TO FOODS AND FOOD ADDITIVES published in
1991 by Blackwell Scientific Publications, witten by D. Metcalfe, H.
Sampson, and R. Simon.

By the way, I nursed my daughter till she was 4.5 years.

Best Regards,
Glenda Deahl, RNC, Still waiting for IBCLC exam results ;>