Abstract
A male infant was born at 36 weeks of gestation with a birth weight of 3,095 g. Soon after birth, he was referred to a local hospital for mild respiratory disorder. On the first day of life, he was able to start oral feeding with normal infant formula; then he excreted bloody stool on postnatal day 3, which suggested that he had cow’s milk allergy. Intake of extensively hydrolyzed formula could not stop the bloody stool. Therefore, pediatric elemental formula (Elental-P®; ED-P) was started on postnatal day 12. However, he was unable to tolerate ED-P because the amounts of gastric residues of ED-P gradually increased. Then, he was transferred to our hospital for evaluation of intolerance to both milk and elemental formula and for starting central venous nutrition. Although oral intake of sugar and electrolyte solution resulted in no gastroenteric symptoms, oral intake of both ED-P and fat emulsion induced poor gastric output and the disappearance of intestinal tract gas, as shown by abdominal X-ray. Oral intake of both own mother’s milk and another elemental formula without soybean ingredients induced no gastroenteric symptoms, and he was well when fed orally without parenteral nutrition. IgE-RAST for cow’s milk and soybean showed negative findings and the drug-induced lymphocyte stimulation test (DLST) for cow’s milk showed positive findings (1,474%). However, DLST for ED-P showed negative findings (167%; cut-off value, 180%). His clinical course suggested that he had food allergy to both milk and soybean ingredients.
