Question
The child has had diarrhea for five months, and various treatment methods have not improved the condition. What could be the possible causes?
Answer
I’m sorry, based on the information you’ve provided: I believe the cause of the child’s diarrhea is still unclear. Although blood allergy tests and skin prick tests suggest a milk allergy, from the child’s overall condition, especially considering the diarrhea after avoiding milk protein, the diagnosis of milk allergy cannot be established. A definitive diagnosis of milk allergy requires a food challenge test. For a child suspected of having a milk allergy, the first step is to avoid milk and dairy products, and switch to amino acid formula or extensively hydrolyzed protein formula to observe any improvement in symptoms, which should take 2-4 weeks. If after 4 weeks of taking the above formula, the diarrhea and other symptoms still do not improve or recur, then the diagnosis of milk allergy should be questioned. Of course, during the 2-4 weeks of avoidance, even if a child is finally diagnosed with food allergy, if they have the following conditions, their diarrhea may still not improve or recur: 1. Not completely avoiding potential allergens: Sometimes this is due to ignoring products that contain allergens such as dairy products that also need to be avoided; sometimes it is due to contact or inhalation of allergens; sometimes other allergens may be present at the same time that have not been avoided, such as eggs and egg products; even sometimes allergies may be non-food sources; 2. Vaccination prevention. These situations have occurred in clinical practice, and indeed, since your child’s diarrhea improved temporarily after using amino acid formula but then recurred again, it is necessary to pay attention to whether any of these situations have occurred. Another common cause of long-term diarrhea in children is infection, but there is also a lack of evidence, especially in terms of pathogenic data. Therefore, my suggestion is: 1. Carefully recall whether there were any of the mentioned situations during the avoidance period; 2. Continue using amino acid formula for 7 days and strictly avoid potential allergens; 3. Conduct a diarrhea pathogenological examination.