what is the likelihood of it improving?

[sapphire21]

My five year old daughter has recenty been given a suspected diagnosis of multiple allergy syndrome. Brief PMH: eczema from about 3 months, only controlled by protopics, bloating, feeling sick, tummy pain. GPs did not warrant it a problem and said she would just grow out of it! She became ill last year and has since been on a milk, egg, wheat, soya diet. Although, we are still unsure of whether she is actually allergic to them as we have never re-introduced them as she is not stable. Treatments have included montelukast, domperidone, movicol, various creams. Now on 30mg lanzaprazole and 5ml cetirizine and azithromycin and various supplements.
Previous diagnosis of EGID from allergist, but upper endoscope showed normal.

Questions are-
1.We have been told she has reflux but we don't know why?
2. will she grow out of it and at what age?
3. why does she bloat to varying extents?
4. Everyone says it is not true allergies as she is not immediate normally to food, although tested positive on skin prick test to grass, cats, feathers. So is this actually a true allergy or just an intolerance. Because if it an intolerance, would a small amount of the possible allergen food make her poorly.
Any advice gratefully received.
PS I have a two year old boy who has just been diagnosed with reflux oesophagitis. He has many facial rashes after eating many foods.

[Dr Helen Brough]

Dear Sapphire21,

Your daughter may have delayed gastrointestinal food allergies which are usually negative on skin prick testing. What has been referred to as 'true allergy' is the immediate allergies which cause hives, swelling and possibly anaphylaxis which are usually positive on skin prick testing.

It is good that an allergist has already considered the diagnosis of eosinophilic gastrointestinal disease and I would ask to be referred back to this doctor for further evaluation. If your daughter has lower gastrointestinal symptoms (loose mucousy stools) then a lower endoscopy might be warranted. I presume your daughter screened for coeliac disease whilst she was on wheat?

Reflux is a symptom (vomiting, nausea, acid brash) rather than a diagnosis thus you may have been told this because of the nausea. I think she needs furtehr evaluation before being able to say when she will grow out of these symptoms as we don't really have a diagnosis yet.

Kind regards

[sapphire21]

Thanks for the advice. My daughter has showed no eosinophils on her upper scope, but do you know if she could have it, even if the eosinophils have not showed up? Or is it completely ruled out?

Also, my daughter had a very bad eczema reaction yesterday where as usual she was crying, especially when her cream was put on. Why does she get so upset when her cream is put on? We have tried many many creams. Today, she is really bloated and uncomfortable.

Also, do you know how long we can use protopic on her? It seems we cannot go more than 5 days without having to use it.

Sorry, many many questions.

[Dr Adam Fox]

lack of eosinophilils doesn't exclude the possibility of a gut allergy although you do, by definitiion, need a certain number of eosinophils for a diagnosis of eosinophilic esophagitis.
Active eczema is sore and sensitive so creams often sting when it is like this. Protopic can be a particular problem. There is no upper limit fo rprotopic being applied (it doesn't seem to thin the skin like steroid creams can) but if stinging is a major problem, a lower strength or elidel may be useful.