Clinical case of early debut of food allergy in a child up to 6 months
ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS | FROM THE EDITORS
Volume 70 • Issue 3 • September 2022, pp. 5-13
Received: 30.08.2022 | Accepted for publication: 31.08.2022 | Publication date: 20.09.2022
1 Scientific-Clinical Consultative Center of Allergology and Immunology, 6 Ostrovityanova st., 117513, Moscow, Russia
2 Association Pediatric Allergist and Immunologist Russia (APAIR), Moscow, Russia
3 Academy of Postgraduate Education of the Federal State Budgetary Institution Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia, Moscow, Russia
Introduction: It is believed that if the child ate only a cow’s milk formula (CMF), and сow’s milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics.
Presentation of the clinical case: a child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2). The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3-4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50% affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid – 0.78 IU/ml (norm <0.3 IU/ml); cow’s milk 0.01 kUA/ l; casein – 0.01 kUA / l (norm <0.1 kUA/l).
Considering the infected AtD, “hydrocortisone + natamycin + neomycin” 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0-1). The cow’s milk formula was returned to the diet without exacerbations of the skin process.
Conclusion: The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate – severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.
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Masalskiy SS, Smolkin YS, Smolkina OY. Clinical case of early debut of food allergy in a child up to 6 months. Allergology and immunology in pediatrics. 2022; 3: 5-13. (In Russ.) https://doi.org/10.53529/2500-1175-2022-3-5-13
Sergey S. Masalskiy
candidate of science, Executive Secretary of Association Pediatric Allergist and Immunologist Russia (APAIR), allergist-immunologist of Scientific-Clinical Consultative Center of Allergology and Immunology.
There is no source of funding
Сonflict of interest::
S. S. Masalskiy, Yu.S. Smolkin is a members of the editorial board