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MSPI overview
Milk soy protein intolerance (MSPI) is the inability to digest the proteins found in cow’s milk and soy foods. This differs from true food allergies (such as hives and anaphylactic reactions) in that it is not a true immune system response. It is more likely a poorly understood metabolic reaction.

MSPI is in more common in children, particularly infants, but also occurs in adults. It can also be referred to by the names eosinophilic gastroenteritis, allergic colitis and food protein-induced colitis. It is a growing problem occurring in 2-7% of babies under one year old. MSPI does seem to have a congenital link as families typically have more than 1 child with it.

Symptoms
Symptoms can manifest in many ways depending on the child.

Common symptoms are:
Blood, water or mucous containing stools
weight loss
chronic congestion
repeated vomiting
gastroesophageal reflux (GER)
asthma
eczema and/or skin rashes
refusing to eat or comfort eating (eating all the time
to soothe the stomach)
irritability or colic-like behavior

Diagnosis
Diagnosis is often difficult as there is no good test for it. Blood work and skin testing can be done to rule out other conditions and to check for specific food allergies though these are not always positive in a child that is allergic or intolerant. Stool testing is also often done to rule out other conditions.

The best diagnostic test is a strict elimination diet. This is done by taking out all dietary sources of milk and soy. If these are the offending agents then there should be a dramatic change in symptoms. It can take up to 2 weeks for the proteins to be entirely eliminated from the body so results cannot be verified until this point. Symptoms should slowly get better during this 2 week period. Sometimes this elimination diet is followed up by an oral challenge test. In this the milk and/or soy is reintroduced (usually one at a time) and the child is watched for a recurrence of symptoms. The oral challenge is used to confirm the MSPI diagnosis.

The most invasive way to test for MSPI is by biopsy of the small intestine. This is done under sedation or anesthesia by a gastroenterologist. Small samples of tissues are taken and analyzed under a microscope to look for the inflammation, increased eosinophilic cells, hemorrhagic tissue and eroded intestinal villi that is characteristic of food intolerances. This inflammation is not specific to MSPI but to food intolerance in general. This erosion and inflammation can lead to poor absorption and malnutrition causing poor weight gain and failure to thrive (FTT). This occurs by the altering of the permeability of the gut mucosa leading to nutrients not being able to be absorbed, known as “leaky gut”. These same inflammatory changes by biopsy can be found in infants who are intolerant to cow's milk based formula but are tolerating soy formula.

Treatment
There are no medications for MSPI. Instead it is controlled by a diet strictly free of milk and soy. For infants this means either hypoallergenic formula or being breast fed by a mother who adheres to a strict milk and soy free diet. For older children and adults this means reading food labels and avoiding all foods containing any milk and soy protein ingredients.

In the past when an infant showed intolerance to cow’s milk based formula they were trailed on a soy based formula. However, in the infants that showed improvement on the soy based formula, as many as 1/4 of them went on to develop a soy protein intolerance as evidenced by a return of their symptoms within 1-2 weeks. These infants are then labeled MSPI.

Many children outgrow their intolerance by 1 year old, though some do in as little as 6 months and some as long as 2 years. Eventually being able to tolerate milk and/or soy will only occur with a strict elimination diet as children will continue to react if they continue to be exposed to the offending proteins.

Are soy lecithin and soy oil safe?

This is something with which you will have to experiment. Some are able to safely eat soy oil and soy lecithin and some are not. In the processing of soybeans into soy oil and from there into lecithin there can be trace amounts of soy protein still left, though this amount depends highly on the individual processing techniques. If you are highly sensitive then you may react but if you are only mildly sensitive then you may not react.

Milk protein intolerance vs. Lactose intolerance

Milk protein intolerance is an intolerance to the actual milk protein. Lactose intolerance is an intolerance to lactose which is the major sugar found in milk. These conditions are often confused as their symptoms are quite similar. One condition is caused by an immune response and the other by a problem with the digestive system. Seeing your physician can help you figure out which is causing your symptoms.