15mo F, multiple food allergies, worsening appetite, dropping percentiles - extensive workup normal, out of ideas
**Age:** 15 months
**Sex:** Female
**Height:** 78 cm (30.7 in)
**Weight:** 8.9 kg (19.6 lb) - \~24th percentile
**Race:** White (Eastern European)
**Duration of complaint:** \~7 months, worsening over the last month
**Location:** Bulgaria
**Existing relevant medical issues:** Severe atopic dermatitis, multiple IgE-mediated food allergies, GERD without esophagitis (K21.9), allergic gastroenteritis and colitis (K52.2)
**Current medications:** Esomeprazole 10 mg once daily (started recently), alginate antacid, children's multivitamin, probiotic
Note! The description below was formatted using AI, but all the information is read and given by the parents.
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**Background**
Born at term, spontaneous vaginal delivery, 3.1 kg. Discharged at 2.9 kg on day 3. Exclusively breastfed 0–12 months, formula since.
Atopic dermatitis began around month 3–4. By month 8 roughly 80% of her body surface was involved with severe pruritus. It correlated loosely with maternal diet while breastfeeding, most clearly with dairy. Managed with intermittent topical corticosteroids. Significantly improved after weaning at 12 months, but still flares periodically.
Solids introduced at 6 months. She gained weight well until month 8, at which point we paused solids for one month due to the severe flare. **Her appetite has never fully recovered since that pause.**
Family history: both parents were thin, poor-eating children. Mother 163 cm / 49 kg, father 178 cm / 72 kg. Father has asthma; maternal grandmother has multiple allergies.
**Allergy testing (specific IgE, kU/L)**
* Cow's milk 65.09 (class 5)
* α-lactalbumin 52.51 (class 5)
* Casein 41.42 (class 4)
* Egg white 33.81 (class 4)
* Peanut 24.76 (class 4)
* Hazelnut 20.36 (class 4)
* Bovine serum albumin 8.12 (class 3)
* Egg yolk, cod, carrot, potato, apple: all <0.35
* Wheat 0.45, rice 0.48, soy 0.41 (class 1, and she tolerates bread daily without issue)
* CCD marker negative
[https://imgur.com/MRKwCmz\](https://imgur.com/MRKwCmz)
An IgG "food intolerance" panel was also done before we knew better — we are aware it isn't validated and are disregarding it.
Epinephrine auto-injector at home just in case.
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**Current eating pattern**
Four meals offered daily. For months she ate roughly half portions plus \~250 ml formula at bedtime, totalling maybe 600–800 kcal/day. Over the past month this has deteriorated: she frequently refuses meals entirely or eats 1/4 to 1/6 of a portion. Estimated intake is now often under 500 kcal/day.
Notable patterns:
* She eats best in the evening and while out walking, worst in the morning
* She best accepts dry bread, fruit, biscuits, formula
* She has had **two episodes of ravenous appetite** — one \~2 months ago lasting 3–4 days, during which she ate 4 full portions daily plus formula and cried for more; another \~3 weeks ago, shorter. Both resolved spontaneously.
* After a gastroenterology appointment she ate near-normal portions for 3 consecutive days, before medication was started, then regressed.
* No vomiting, no food impaction, no pain on swallowing, no nocturnal waking
Growth: she has tracked steadily at roughly the 25th–40th percentile for weight throughout her first year. Height appears normal.
**She is energetic, constantly active, developmentally on track, drinks well, 6+ wet nappies daily, 3–5 normal formed stools daily.**
**Workup**
[https://imgur.com/a/GJrOeq6\](https://imgur.com/a/GJrOeq6)
[https://imgur.com/Vs9pA9c\](https://imgur.com/Vs9pA9c)
[https://imgur.com/iGmlJHT\](https://imgur.com/iGmlJHT)
[https://imgur.com/W3z8rnx\](https://imgur.com/W3z8rnx)
[https://imgur.com/a4rsQzE\](https://imgur.com/a4rsQzE)
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**Growth Chart**
[https://imgur.com/qc8s48v\](https://imgur.com/qc8s48v)
Also from today - 8.93 KG
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Abdominal ultrasound: liver homogenous, normal echogenicity, not enlarged. Spleen and kidneys normal. **Stomach elongated and still full of food 2.5 hours postprandially. Prominent bowel gas on auscultation.**
**Specialists seen:** 2 paediatricians, 2 allergists, 3 dermatologists, 1 paediatric gastroenterologist.
Observation: the baby is a bit yellowish / orange, but could be that this is her skin color. It was also noted by the gastroenterologist.
**Current plan:** empirical PPI + alginate for 2 months, reassessment at 3 weeks. Genetic testing for Gilbert syndrome and repeat allergen panel pending.
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And finally, what would you suggest us do? What specialist or any additional blood tests or ideas that you have for us, please share them and let us know!