Is My Baby Dairy Intolerant? Food Protein Induced Allergic Proctocolitis (FPIAP) with Marion Groetch, MS, RDN

Marion Groetch (0s):

Basically you'll see blood in the stool in a very young infant. It usually appears somewhere in the first few weeks up to maybe the first few months of life, you'll start to see maybe some blood in the stool. Many infants have only blood in the stool, probably within some accompanying mucus, and they're otherwise very well-appearing. Growing well, happy infants, but as a parent as you can imagine, it's quite alarming to see blood in the stool.

Katie Ferraro (28s):

Hey there, I'm Katie Ferraro, registered dietician, college nutrition professor and mom of seven specializing in baby led weaning here on the baby LED weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Let's say you're feeding your baby brass milk or formula and very early on in infancy you notice some blood or some mucus in the stool and you freak out a bit. Then you hop online, ask around, start exploring and then this idea's popping up. Ooh, maybe my baby's dairy intolerant. Okay, this blood and mucus and the stool during infancy, it actually occurs a lot more frequently than you might think.

Katie Ferraro (1m 11s):

And while it feels and sounds scary, it's actually quite manageable. So my guest today is Marion Groetch. She's a registered dietician specializing in food allergies. Marion has over 25 years of nutrition care experience. She's the director of the nutrition services at the Jaffy Food Allergy Institute. She's an assistant professor of pediatrics at the ICAN School of Medicine at Mount Sinai and she's very heavily involved in food allergy research, educational programming, teaching writing. She's in infant feeding and pediatric food allergy guru. And I can say personally I have so enjoyed learning from Mary and I recently completed a yearlong advanced pediatric food allergy training for dieticians that she co-teaches with Carina Venter, who's another leading pediatric food allergy research.

Katie Ferraro (1m 51s):

Carina has been on this podcast a number of times as well, so you might recognize the name. But Marion Roach was previously on the podcast in episode 230. She was teaching us about FPIES food protein induced enter colitis syndrome. So FPI is a really rare type of non IgE mediated food allergy. So the delayed one, not the really quick onset IgE food allergies that you might be familiar with. So I invited Marion back on to talk about another non IgE mediated food allergy called food protein induced allergic proctocolitis. So the abbreviation is FPIA, but we usually just call it allergic Proctocolitis or Proctocolitis in feeding. So basically it's that blood and mucus in the stool stuff early on in infancy that causes parents if they're formula feeding to switch to a hypoallergenic formula or if they're breastfeeding causes mom to start all sorts of elimination diets where she's cutting a bunch of things out like dairy and soy, et cetera.

Katie Ferraro (2m 41s):

So if you've had a baby with blood or mucus in the stool and you're considering this elimination diet or the switch to hypoallergenic formula, this is a really important episode to listen to and Marion's gonna share. And I, I really want you to pay attention if if this has happened to you. The important takeaway message here is to be reintroducing the trigger food as soon as four weeks following the resolution of symptoms. So what happens is the blood and the mucus clears up and then parents will be continuing to avoid big groups of food including the allergenic foods, which when you start solid foods is not advisable because then we're increasing the risk of the other types of food allergies, the IgE mediated food allergies. So Marion will explain more in detail. With no further ado, let's get into the episode. This titled is "My Baby Dairy Intolerant Food Protein Induced Allergic Proctocolitis with Marion Groetch".

Marion Groetch (3m 29s):

Thanks for having me.

Katie Ferraro (3m 30s):

So I learned so much from being a part of you and Karina's pediatric food allergy course for dieticians I did earlier this year with you. So before we dive in, I just wanna ask you if you could share a little bit like what projects you're working on right now in either infant feeding or pediatric food allergy that are really exciting. You?

Marion Groetch (3m 46s):

Well, there's so many because all I do is infant feeding and pediatric food allergy. Speaking of F PIs, because that's what I spoke about last time, I'm actually just starting a study looking at ion deficiency anemia in F PIs or iron deficiency because you know that in F PIs we alter the complimentary feeding schedule and sometimes that can impact iron intake. So we're looking at our patients with F PIs and seeing what the prevalence of iron deficiency is. And I think that's actually going to be really important for all patients with ffis because if we know that this is a problem, we'll be able to address it before it happens. So I'm looking forward to doing that work.

Marion Groetch (4m 26s):

I've done a lot of work in prevention of food allergies and I was recently invited to speak on a panel of experts at the USDA. They are actually looking at the WIC packages. So WIC is women infants and children and they provide food for families who are in need, but they also try to address nutritional issues. And we talk to them about the importance of early introduction of allergens and prevention of food allergy. And we're hoping to have an impact on that. We're also developing an educational program for the WIC nutritionist so that they understand that early introduction of allergens is important for prevention of food allergy.

Katie Ferraro (5m 8s):

And I think that's so important. We've actually, we had Darlene Birch on from the National WIC Association recently. We were talking about a lot of the proposed changes to the WIC food package and understanding how slow things get done in a government bureaucracy, et cetera. But really addressing this gap about the allergenic foods. I do, I speak at the state level, I've spoken for almost all 50 of the state WIC associations at this point about introduction of solid foods. And we always talk about allergens and they say, well that's great, except if you look at the WIC package and the provision for babies at six months of age, it's not there. So you're telling us that the research says early and often introduction of foods like peanut is important. We turn around and you know, half of all babies in this country are on the WIC program. And so it's a massive gap as far as the provision goes.

Katie Ferraro (5m 48s):

So I think it's wonderful to hear that not only practitioners but researchers, the policy people are finally starting to get the message. But it's really taking too long.

Marion Groetch (5m 56s):

My opinion, it is taking too long. And I agree with you and it is kind of shocking that more than half of the infants that are born in this country are eligible for wicWIC. And it's true if the food is not in the package, it's going to be very difficult for us to have those nutrition professionals talk about early introduction. But what I'm most excited about, and I wanna tell you cause I think you'll be excited about this, is that Karina and I have a new textbook that's coming out soon. It's called A Health Professionals Guide to Managing the Nutrition Management of Food Allergies. And we collaborated with two physicians, John James and Scott Fisher. And we have created a really wonderful resource. I think it's gonna be very important for dieticians and other healthcare practitioners who are looking to manage food allergies in their population.

Katie Ferraro (6m 42s):

Well you guys just wrote a textbook in your spare time like you are, you and Karina are two of the busiest people that I know and I'm very impressed with your the output.

Marion Groetch (6m 51s):

We collaborated with so many professionals. So each chapter is written by a team of a dietician and a physician at least one of each. And these are the people who are the experts in that topic. We did most of the editing and of course Korean and I each wrote a number of the chapters ourselves. But still it's, it's really a work that is done by so many wonderful practitioners out there that we're really grateful that they came aboard for

Katie Ferraro (7m 16s):

Us. I think we need that so much. I, I still teach, I'm a college nutrition professor much less than I used to be. I teach one nutrition throughout the lifecycle class and a couple of cultural foods classes. But you know, nutrition throughout the lifecycle, they're still using a textbook that recommends starting with white rice cereal at four months of age, no mention of of the allergens. And, and it's a recent publication date, like this research is not trickling down to healthcare professionals. So again, I think it's so important that's your area of expertise, that you have that textbook and that educators like myself can turn around and say, this is the current stuff because we are in many cases still teaching outdated information. And I would argue that physicians, it's worse for the physicians cuz they get hardly any nutrition. And then when they do, it's not always current, but dieticians also need to step it up a little.

Katie Ferraro (7m 58s):

So when can we expect that book?

Marion Groetch (7m 60s):

I think, you know, we're really in the very final phases. We're looking at the copy edits right now, I think maybe by January. Okay. It'll also be a companion to our course.

Katie Ferraro (8m 9s):

I know I did take your course and I, I saved all like the readings were all over the place though. I mean we had to have obviously, you know, this publication and that article and, and I love that because those are all the source documents and that's what we should be reading. But it would be nice to have it all kind of tied up at the end. Cuz you should have seen my binder at the end of that class. It was like lots and lots of printed out articles. I'd love a textbook that sums it up,

Marion Groetch (8m 28s):

Right? We'll still have lots of, lots of articles because the truth is that every year new research is coming out and we are on the top of the field. So we wanna make sure that we're giving the most up-to-date information.

Katie Ferraro (8m 38s):

Well if you are a registered dietician and you work in the world of infant feeding or food allergy, I can't recommend Karina and Marion's course enough. It was, it was a year long commitment. It was the hardest I've used my brain, I have to be honest since I've had children. But it was so well laid out and I think it's so important especially that, that dieticians have more opportunities for advanced training and important topics like this. So I'll put a link to the course that's run through Fair Food Allergy Research Education. That'll be on the show notes page for this episode. So MI you mentioned last time you were here we were talking about F pies, food protein induced enterocolitis syndrome and it's incredibly rare, which is why we waited 230 episodes until we covered it. Cuz I just personally don't want parents to think every time their baby vomits that it's FPI symptoms.

Katie Ferraro (9m 20s):

And you did a great job explaining fpi. So that's episode two 30, but today we're talking about food protein induced allergic pro colitis. So that's a mouthful. Could you summarize exactly what this diagnosis means? Is it a diagnosis, is it a prognosis? What does the term encompass?

Marion Groetch (9m 38s):

So it's actually a diagnosis and I agree food protein induced allergic practical colitis is really a mouthful. So I'll probably just be using the term pro colitis as I move forward or allergic pro colitis. But the condition involves basically you'll see blood in the stool in a very young infant. It usually appears somewhere in the first few weeks up to maybe the first few months of life you'll start to see maybe some blood in the stool. Many infants have only blood in the stool, probably within some accompanying mucus and they're otherwise very well appearing, growing well, happy infants. But as a parent as you can imagine, it's quite alarming to see blood in the stool.

Marion Groetch (10m 22s):

Some infants will also have some other symptoms. They might be fussy or gassy, but really mostly very well appearing infants. This condition is a diagnosis, it is what we call a non IgE mediated food allergy. So it is a food allergy. There's some confusion about whether pro colitis or allergic pro colitis is a food allergy or a food intolerance because in the past it was often called cow's milk protein intolerance and sometimes even in the GI world or pediatricians might still use that term, but in fact it is an allergy. It's a non IgE median allergy, which is different from IgE media allergies.

Marion Groetch (11m 5s):

So IgE is immunoglobulin E. So IgE median allergies are those allergies that we commonly think of when we think of food allergies. They are rapid in onset soon after ingestion of the food we might see hives or swelling. We might see rapid or very quick onset of vomiting soon after we ingest the food. So it's usually within minutes to up to about two hours after the food has been ingested. You might even see symptoms of the respiratory tracts or coughing or difficulty breathing. These are what we think of when we think of food allergies. Non IgE media allergies are things like food protein, induced center colitis syndrome, or FPIES or food protein induced allergic Proctocolitis or what we're talking about today.

Marion Groetch (11m 53s):

These are types of food allergies that are tend to be more delayed in onset and we cannot test to determine what food is causing the reaction. So the way we diagnose these is based on the clinical presentation and also if the symptoms resolved once the food has been eliminated and if the symptoms recur once the food is reintroduced.

Katie Ferraro (12m 19s):

Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (13m 3s):

So when we talk about IgE versus non IgE, a lot of parents are aware of food allergy testing for IgE mediated food allergies. We've had Dr. Stukas on talking about, you know, the big problem with false positives in food allergy testing. But is the reason why we can't test to determine what causes the non IgE mediated food allergies. Is that just because good tests haven't been developed? Are there different biomarkers in the future? Do you think we'd be able to test or is it always gonna be based on this clinical presentation like you described?

Marion Groetch (13m 31s):

I think that in the future we may have some tests, but right now there are no validated tests. There are no tests that have been shown to actually really predict what foods or triggers for this. The tests that we have for food allergy measure immunoglobulin E or IgE. So when you do a prick skin test for instance, it's measuring a reaction that is triggered by IgE. And the same thing when you're doing a serum blood test, it's looking for IgE. Many people think that they can measure IgG or they can look at mediator response and these might correlate with a non IgE media food allergy. But that is really not the case and people should not be fooled by these tests because they're very expensive and they do not predict which foods are going to trigger the allergic

Katie Ferraro (14m 20s):

Reaction. And I think that that message is finally trickling down to parents who've had a lot of discussion, especially on, I've been on a number of other science based podcasts where we're talking about, you know, this whole idea of food sensitivity testing. You know, it was a big deal in the dietitian world. I remember a decade ago I used to work in private practice in adult nutrition. It was a huge thing that private practice dieticians did. And it's, it's so shady, it's not based on any science. And yet today you still will see a lot of products out there for food sensitivity testing. And the worst thing would be to see that in marketed to infants. Because as we know they don't, they don't, don't work across the board. But we don't wanna prey on parents' fears. So what you're saying if, if I can rephrase it is, is there's no way to really test for this. You need to be working with a clinician who's trained and not getting your information off of TikTok, if I may,

Marion Groetch (15m 3s):

Absolutely. I had a patient yesterday, literally just yesterday, who came in with a whole slew of testing IgG tests and also something else that I had never seen before. And you know, unfortunately this was a four year old child who had been eating all these foods and tolerating them all and mom was in the process of eliminating all these foods that this child was tolerating. And it's really a bad idea. It can result, you know, elimination diets are not easy to follow. People who need to follow those will let you know that it has a huge impact on their quality of life and we don't wanna impose that on people who don't need

Katie Ferraro (15m 37s):

It. We're talking about earlier the blood and mucus in the stool early on in breastfeeding and you know, you hear that anecdotally from a lot of parents. Oh yeah, gosh it's so scary, right? This is a brand new baby, you just came home, I'm trying to figure out breastfeeding now there's blood and mucus in the stool. Parents do end up though being reassured once they know or learn that it's something that's not very super serious and actually quite common. So about what percentage of the population is affected by allergic pro colitis?

Marion Groetch (16m 5s):

So that's, I would say that's really all over the place. The, the literature is not really consistent when it comes to that. There was a study out of Boston two years ago that found a very high rate of food protein induced allergic pro colitis in a pediatric cohort that they sort of enrolled prospectively. The cumulative incidents was 17% but that dropped down to 7% when the diagnostic criteria was narrowed. So in order, in order for us to say that this is pro colitis, we really wanna see visible blood in the stool. You don't wanna be testing the stool to see whether there are invisible traces of blood. So that's something that we don't usually encourage.

Marion Groetch (16m 45s):

Sometimes it's done if an, if an infant is sick and infant is not well, but for a well appearing child we don't do that's. Other centers have said, you know, maybe two to 3% of the population, like I said, it's all over the place. But like you said, it is very alarming if you're seeing blood in the stool. But we almost think of it as a benign symptom. The infants are, well it's not hurting them, it's painless but you want it to resolve.

Katie Ferraro (17m 14s):

So when a mom has a new mom breastfeeding blood or mucus in the stool, more often blood occasionally mucus, they often look immediately to the internet and they start looking at all these elimination diets. And so how does altering mom's diet early on in infancy when breastfeeding affect allergic proctocolitis in the baby? Does it work? Is it necessary?

Marion Groetch (17m 33s):

Two very good questions. Does it work and is it necessary? Well the first, first thing I wanna do is backtrack a little bit because we're talking about the breastfeeding mom. But this also does happen in infants who are formula fed. It's about 50-50, maybe a few more percentages for for the breastfed mom. But for the formula fed infant you would just switch to a hypoallergenic formula and then usually the symptoms resolve very quickly. For the breastfeeding infant, you would probably want to eliminate the most commonly implicated food first, which is

Katie Ferraro (18m 7s):

Cow's milk protein,

Marion Groetch (18m 8s):

Right? So we would eliminate milk first. It's the most commonly implicated food followed maybe by soy and and maybe egg. But really the vast majority of infants have resolution with just the elimination of one food and that's cow's milk protein from the diet. So when would you expect to see the, the symptom of blood in the stool resolve? So in general, in this very new study that was just published this year, the resolution of blood in the stool, the median time to resolution was three days for blood in the stool. But the interesting thing about this study is that they looked at all the different symptoms and looked at the resolution of symptoms for each individual symptom.

Marion Groetch (18m 49s):

So blood in the stool will resolve usually within three days by two weeks 80 plus percent of infants had no longer had any blood in the stool. So that's actually pretty good. The mucus, however, takes longer to resolve. And this is actually very important because if moms are looking to resolve the mucus in the stool and they think, oh I've eliminated milk from my child's diet and the blood has stopped, but now there's mucus so maybe there's another allergen, so now I'm gonna eliminate soy and then that doesn't resolve it and then I'm gonna eliminate egg and wheat and nuts and corn. And before you know it, four weeks have passed and now the mucus is gone.

Marion Groetch (19m 30s):

And you don't know whether any of those foods were implicated or if it was just time

Katie Ferraro (19m 36s):

You said blood and mucus and then some other symptoms. Are there other symptoms or is it pretty much blood and mucus in the

Marion Groetch (19m 41s):

Stool? In this most recent publication, they gave fussiness and gassiness as common symptoms. You know, obviously much less than 50% had these symptoms but they were present in some of these infants. And of course you know when you have a brand new baby and you are hoping to make them comfortable and want them to sleep, you know the fussiness and the gassiness is really something you want to resolve.

Katie Ferraro (20m 5s):

When you mentioned that the allergic proctocolitis affects about 50-50 formula fed and breastfed babies for the formula recommendation, you said the mom would switch to a hypoallergenic formula for the baby. Can you explain what that means?

Marion Groetch (20m 19s):

So hypoallergenic formulas in this country have to be tested and they have to actually be tested and the cows milk allergic population and 90% of infants with cows milk need to be able to tolerate this formula in order for it to be considered hypoallergenic. Now there are a whole bunch of hypoallergenic formulas they do, some of them actually have cow's milk protein in them, but they're so broken down that the infant's immune system doesn't recognize it. And then, then there are even more hypoallergenic formulas that have no milk proteins in them whatsoever, just individual immuno acids. And these are our most hypoallergenic forms of formula

Katie Ferraro (20m 59s):

And the most expensive

Marion Groetch (21m 0s):

And the most expensive and they don't taste very good. But you know, usually when proctocolitis occurs in very early infancy, infants will accept almost any flavor formula.

Katie Ferraro (21m 11s):

If mom eliminated dairy and or then soy early on in breastfeeding, does that mean that she will always need to do that throughout the duration of her breastfeeding journey for that the half of this population that is breastfeeding?

Marion Groetch (21m 24s):

So, That's a really good question. So you know, when we talk about the diagnosis of food protein, induced allergic proctocolitis, elimination of the allergen and resolution of the symptoms is the first step. The second step is reintroduction of that allergen to see a recurrence of the symptoms because there are actually a number of studies that have shown now that you know, this type of blood in the stool may be just transient and it might not be related to the food at all. So we don't want moms to be on these elimination diets for a long period of time if it's not necessary.

Marion Groetch (22m 5s):

What I would say to that is that in clinical practice the reintroduction step almost never happens. And I don't know why that's true, I think it might be because parents are alarmed by blood in the stool, so they don't want to, their infant is finally looking better, they're not bleeding anymore. And they might say, you know, it's not a big deal for me to eliminate these foods from my diet so I'll do it. So usually what we would say and what our guidelines say is that four weeks after resolution and the symptoms, you should try to reintroduce either the milk or the soy back in the diet. If you've eliminated both, you would start with soy first.

Katie Ferraro (22m 42s):

Does the same go for the formula four weeks after the resolution of the symptoms, you can start trialing back to a standard formula instead of the hypoallergenic ones.

Marion Groetch (22m 50s):

Yeah, I, I would just try a small amount of it.

Katie Ferraro (22m 52s):

Okay, so four weeks, that's, you're right in, in real life parents are not doing the reintroduction step because,

Marion Groetch (22m 58s):

Because parents are generally not doing that. Now having said that, you know, for the mother who is breastfeeding, you know, if their infant had symptoms to their breast milk then they happen to be the type of mom or their biology as such that they are actually secreting immunologically active proteins in the breast milk. Not all mothers do that. About 50% of of moms will have no immunologically active cow's milk proteins coming through their breast milk. But if the infant is having symptoms, they probably are now the amount of milk protein in the breast milk is actually quite low. And there is some data that indicates that small amounts of milk in the maternal diet or some milk in the baked form might be tolerated.

Marion Groetch (23m 45s):

So I think it's okay for moms to go ahead and try that in their diet.

Katie Ferraro (23m 50s):

Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (25m 3s):

And we've had Karina's come on to talk about using egg ladders and how that works and the differences in the proteins and stuff. And I, I think again, this is starting to kind of reach mainstream parenting culture a little bit more and just knowing that the way I, I've learned a lot about the way clinicians in Europe, for example, are allowed to participate in the reintroduction and how that differs, especially with dieticians from what we do in the United States. And so we have lots of parents who are, well I've, I've read this paper from the UK and there's a lot that goes into, well, well how come this isn't kind of mainstream stuff? And I think a lot of times there's, there's a timeline. So we're talking about the first few weeks of a baby's life and then they come into my realm of infant feeding at six months of age. And so mom's like a lot of other stuff has been happening.

Katie Ferraro (25m 45s):

Which leads to my next question. These parents, they had this early on in feeding and then they assume, well my baby can now never eat dairy and or soy if that's what triggered the symptoms when I was either breastfeeding or bottle feeding. Is that true throughout infancy, you know, six months later, do we need to be cautious of introducing these allergenic foods to those infants who, who did have signs and symptoms of allergic pro colitis early on in their life?

Marion Groetch (26m 10s):

Look, this is one of the most quickly resolving food allergies. So the family really should discuss with their doctor when they can try the trigger food again. Generally this is done somewhere between nine and 12 months of age. By one year of age, most children will tolerate the trigger food for food protein allergic proctocolitis.

Katie Ferraro (26m 29s):

Okay, sorry. Timezone though, like parents are also hearing the message, like the protective window for the introduction of allergenic foods appears to close somewhere around 11 months of age. And these parents know the one thing I can do to reduce my baby's risk of food allergy is to introduce allergenic foods. So then when they're told to wait on the trigger food till after 12 months of age, and a lot of times doctors just say that off the cuff, just wait till after one. Is there really like, like guidance and protocols that that say that? Or could they do it a little bit early and maybe get some of that beneficial effect of early introduction for food allergy prevention?

Marion Groetch (26m 59s):

Yeah, so I agree with you and food algebra, we don't know a lot about milk introduction, early introduction of milk and whether that's protective. On the other hand, we do know again from a case series from Boston that these children with food protein, and has allergic proctocolitis were more likely to have IgE mediated allergies and the authors proposed that it might be because of the elimination diets that we impose on them early on. So I, I agree with you 100% that parents are coming in and saying, Hey, can I try a little bit of of milk? And you know, personally, this is my, my personal opinion, I would probably try like a teaspoon of yogurt to see how it goes.

Marion Groetch (27m 42s):

Of course I would have the family discuss this with their doctor and I would always check with my doctors, the ones that I work with to say, Hey, can we try to introduce a little bit of yogurt in this, in this infants diet and see how they do. I don't know if anybody is systematically reintroducing these foods like on a monthly basis to see when they actually outgrow it. We know that by 12 months most have outgrown it, but maybe they're outgrowing it at six months, maybe they're outgrowing it at, you know, four months. We're not looking at it systematically.

Katie Ferraro (28m 14s):

And the outgrowing piece, their parents always ask about that and I know it's really hard to quantify, but you mentioned that the allergic project colitis is one of the most quickly resolving food allergies. So even though it might feel very overwhelming and very terrible and very scary, this is not a lifelong sentence is, is that kind of the messaging that you use in clinic for parents who are feeling very anxious about this diagnosis?

Marion Groetch (28m 36s):

Yeah, I mean I think the good news with practical colitis is that the vast majority will outgrow it very quickly. We don't typically see a lot of IgE mediated allergies coming out of it. You know, if the infant has, I I think that, you know, the important thing is that the allergist or their physician, sometimes the pediatricians are managing practical because it's kind of simple to manage, especially if the infant has no other allergic disease, they don't seem to have any other symptoms, they're not having any IgE media allergies, they're not having, you know, terrible eczema, which is a risk factor for developing IgE media allergies. If they're not having any of those things, the, the allergist or the pediatrician might say let's go ahead and try to introduce a small amount of this at home.

Marion Groetch (29m 21s):

If the physician senses that this patient might also have some IgE needed allergy, they might want to test to milk because if that infant has a is sensitized to milk and when I say sensitized, I mean they have a positive test. So if they have a positive test to milk the way that that, that that milk is going to be introduced will be different, then the physician might say, you know what, why don't you come into the office and try it here where I can supervise and if there is any problem we can treat it. And I think that's helpful for parents as well.

Katie Ferraro (29m 57s):

Are there guidelines around age for that testing cuz parents hear conflicting information about that as well. Like some I won't even test till after one. Well I wanna test prior to one so that you can then be introducing it and potentially be helping to prevent food allergy. Is there any hard and fast rules about age for testing for the sensitization for example, to cows milk protein?

Marion Groetch (30m 16s):

So there's no hard or fast rules about when they should for, for practical colitis I would say that you can test, you know, a newborn baby. I mean you don't need to be a certain age if you want to test for that, that food sensitivity or sensitization. But what I would say is the vast majority of infants that have food protein induced allergic pro colitis will not be tested prior to introduction.

Katie Ferraro (30m 41s):

Okay. There's not a higher risk of IgE, immediate food algae. And if there are, like you were saying from that Boston series, it looks like it might be related to withholding and delaying the introduction of those proteins.

Marion Groetch (30m 49s):

Yeah, it's, it's hard to know. Yeah,

Katie Ferraro (30m 51s):

Still a lot of gray area I feel like is like the ultimate job security for people with food allergy. Like we learn a little bit but it's like never exactly clear and we're learning so much every month it feels like.

Marion Groetch (31m 0s):

I think, you know, the more you dig into it, the more the more complex it gets. But really it's quite simple blood in the stool, remove cow's milk from the diet, you know, wait and see whether the blood resolves as it does just sort of ignore the mucus for a while if that doesn't resolve, you know, after a month or so you might wanna try to eliminate soy as the next step. And egg is the third step. Honestly, I don't think I would go crazy thinking about it, but even if you do not remove any food from the diet and the, the baby continues to have streaks or a little flex of blood in the stool, it's probably not going to harm them. Some parents just choose not to make any dietary intervention and you know what a, a good percentage of those children have resolution of the blood without any dietary intervention.

Marion Groetch (31m 49s):

So keep that in mind. We don't have to get so complicated about

Katie Ferraro (31m 52s):

This. And just a second, what you said earlier, what we don't wanna see are parents and caregivers unnecessarily withholding large categories of food, including the allergenic foods cuz it's not easy to cut out cow's milk, protein and egg and peanut. And if you don't need to, it can actually make your life a lot simpler as you help your baby transition to solid foods.

Marion Groetch (32m 11s):

It can make your life simpler. And you know, these foods are important nutritionally as as you know. And not only that, if we are withholding foods, especially in an infant who has eczema, we may actually, you know, cause them to have more immediate symptoms of the food. And that's something you really want to avoid. So, you know, we eliminate what's necessary and we feed what's not necessary to eliminate.

Katie Ferraro (32m 36s):

Well thank you for clarifying. Cause I think it is a scary topic, but parents have peace of mind when they realize I'm not the only one doing this. There's researchers and groups like yours out there really helping to simplify it, which I appreciate it. And could you tell our audience where can they go to learn more about food protein induced allergic proctocolitis and the work that you and your team are doing in food allergy awareness and prevention?

Marion Groetch (32m 56s):

So I think really the best place to go is there are two good places to go. One would be the American Academy of Allergy Asthma and Immunology. So it's aaaai.org. So we call it Quad ai and the other place would be food allergy research and education. So fair. And their website is food allergy.org. They have great information on all types of allergies and also really nice information on how you can get involved if you're interested in, in taking part in research.

Katie Ferraro (33m 29s):

Wonderful. Well thank you so much for your time. I really appreciate it.

Marion Groetch (33m 32s):

Thanks for having me.

Katie Ferraro (33m 33s):

Well, I hope you guys enjoyed that interview with Marion Groetch. It is so amazing that researchers who are leaders in their field, like Marion and Carina will come on and kind of simplify what can in many cases be really, really confusing messaging and conflicting messaging about important things like foods that our babies can't eat, or foods that you might be eliminating from your diet. And hopefully you, you got that takeaway message that this is a very quickly resolving type of food allergy and it is not a lifelong sentence and your baby doesn't have to avoid big groups of food for the rest of their life. And you don't have to either. So I'm gonna link up all of the resources and a lot of the research papers that Marion mentioned in this episode. That'll all be for you on the show notes page for this episode, which you can find at blwpodcast.com/284.

Katie Ferraro (34m 16s):

Thank you so much for listening.