A kwashiorkor case due to the use of an exclusive rice milk diet to treat atopic dermatitis
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Although several cases of severe hypoalbuminemia resulting from rice milk have been described in the past, today the use of rice milk without nutritional counseling to treat eczema is still a continuing, poor practice. We describe a kwashiorkor case in an infant with severe eczema exclusively fed with rice milk. It is well documented that rice milk is not a sufficient protein source. Moreover, only a small portion of eczema is triggered by food allergy. In conclusion this case raises the importance of managing dietary changes facing food allergies with responsibility for specialized consensus among pediatricians, nutritionists, endocrinologists and allergists all of them specialist professionals.
KeywordsAtopic Dermatitis Food Allergy Severe Atopic Dermatitis Severe Eczema Nutritional Surveillance
We describe a case of severe hypoalbuminemia provoked by an unnecessary and inappropriate elimination diet based on rice milk in an infant with severe atopic dermatitis (AD), which was thought to be secondary to food allergy.
An exclusively brestfed boy infant developed AD at the age of 4 months. In the beginning, the eczema was treated with antibiotics, topical steroids and brief courses of oral steroids. The mother was dissatisfied by the outcome of the pediatrician’s advice so she consulted a naturopathic doctor who prescribed a restricted diet.
At 6 months the child’s daily diet consisted of rice milk, fruits, rice poultry and vegetable broth.
After few days diuresis increased and weight initially decreased. Eczema improved and scratching was less evident thanks to topical treatment. Haematic examinations performed on day 10 showed a normalization of total protein, albumin and clotting tests. On follow up the skin prick test was negative to milk and egg allergy.
Because of a long lasting low blood calcium level (7.3 mg/L), he developed demineralization of his teeth, persisting at the follow up visits up at 2 years of age.
This kwashiorkor case highlights the potential danger of inappropriate elimination diets in infants with AD, and illustrates the need for careful nutritional guidance in the management of AD. The use of rice milk resulted in hypoalbuminemia and poor weight gain.
Eczema is a chronically relapsing inflammatory skin disease and one of the most common skin disorders affecting up to 17 % of children , and it can rarely be managed with dietary changes alone.
This case reinforces the concept that hypoallergenic diets should be managed by allergists with experience in food allergies. Consultation and consensus should be achieved between specialists in pediatrics, allergy, nutrition and endocrinology, before adopting severely restrictive diets. Consequently, the choice of an elimination diet should be limited to children with moderate to severe eczema not controlled by topical steroids, under strict nutritional surveillance [6, 7, 8].
Written informed consent was obtained from the patient for the publication of this Case Report and any accompanyng images. A copy of the written consent is available for review by the Editor-in-Chief of this Journal.
The authors express their gratitude to the parents of the patient, who graciously authorised the publication of the information here expressed.
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