Page 34 of 73 INTOLERANCE OF FOOD PROTEINS
Under the influence of specific food proteins in intestines of the child there can be side reactions. They in many cases treat an allergy, but often there are no proofs of true allergic reaction therefore more we accept the term "intolerance". As reliable laboratory criteria of this state are absent, the diagnosis is based on clinical supervision over reaction of the intestines to reception "suspected" a squirrel or removal it from food. The majority of cases are the share of chest age that connect with intolerance of proteins of cow's milk.
Intolerance of proteins of cow's milk
Due to the lack of reliable diagnostic criteria the exact assessment of frequency of cases of this intolerance is complicated; it is known that in Sweden this state is observed at 0,5 — 1,5% of children; in the USA this indicator is much less than 0,5%.
Clinical manifestations. At intolerance of cow's milk there can be various clinical syndromes; at such patients and their relatives the frequency of allergic diseases is increased (eczema, asthma, etc.).
Acute diarrhea and vomiting. At babies the intolerance of milk is, as a rule, shown sharply, characterized by vomitings and a frequent liquid chair, sometimes with blood impurity that indicates damage of a large intestine. At a fulminant current hypostasis of a throat and an acute anaphylaxis is possible; in such cases urgent measures are necessary for rescue of life of the child. Fecal masses contains a large number of eosinophils and erythrocytes.
Chronic diarrhea and disturbance of absorption. Sometimes the intolerance of milk is shown by a bad general state and chronic diarrhea owing to what it is slowed down or even growth of the child stops. This syndrome is observed at children of preschool age and is explained by dysfunction of a small bowel (an easy steatorrhea and disturbance of absorption of D-xylose). In bioptata of a small bowel focal changes of a mucous membrane of various intensity are visible: fibers are shortened, crypts are extended, the quantity of lymphocytes in an epithelium is increased and cellularity of own plate is increased. It should be noted what once taken bioptat can be normal. The most part of cases of this chronic syndrome is registered in the European countries.
Excessive loss of protein and blood through a digestive tract. This syndrome which is found generally at children of preschool age is shown by widespread hypostases, a hypoproteinemia and iron deficiency anemia. Diarrhea is possible; in certain cases intestinal symptoms are absent. After the termination of reception of cow's milk loss of protein and blood through a digestive tract stops. Often emergence of the specified signs matches transition from food by artificial milk mixes to the use of genuine fresh milk.
Diagnosis. The intolerance of milk protein is diagnosed on the basis of clinical supervision. Acute symptoms disappear in 48 h, and chronic — by a weekend after full cancellation of milk. The provocative test which is carefully carried out after a while with milk allows to take out the correct diagnostic judgment. At children of early age, especially at suspicion on a possibility of an acute reaction, provocation it is necessary to carry out at continuous supervision, since 1 — 5 ml of milk and gradually raising a dose within several days. Skin tests, definition of a complement, and also antiserum capacity in blood and Calais do not play any role in diagnosis. In many clinics at a chronic current results of provocative test estimate on morphological changes in a bioptata of a mucous membrane. It is important to exclude other states with similar symptomatology, such as acute intestinal infections, a lactose intolerance and other forms of a chronic nonspecific inflammation of intestines.
The clinical syndromes described above can also arise as reaction to protein of soy. According to some information, the intolerance of proteins of soy is observed at 50% of the children who are not transferring milk. The intolerance of soy is revealed by the same methods, as intolerance of milk.
Treatment. Rather long breastfeeding reduces probability of emergence further of intolerance of cow's milk. Treatment consists in an exception of food of the corresponding products. The nonmilk diet includes various products from soy and meat. Sometimes the children reacting to milk protein well transfer dairy products which contain the hydrolyzed protein. At many children with a belkovodefitsitny enteropathy there comes improvement upon transition from genuine fresh milk to undergone processing (for example, powder). In cases of polyvalent food intolerance oral administration of a kromoglikat of sodium suppresses intestinal symptoms and gives the chance to eat fully.
Forecast. The intolerance of food proteins, as a rule, has tranzitorny character. Within one year it disappears at 50% of patients, at most of the others — on the second year of a disease.