Cow’s Milk Protein Allergy Flashcards
What is cow’s milk protein allergy?
Cow’s milk protein allergy is a condition typically affecting infants and young children under 3 years. It involves hypersensitivity to the protein in cow’s milk. This may be IgE mediated, in which case there is a rapid reaction to cow’s milk, occurring within 2 hours of ingestion. It can also be non-IgE medicated, with reactions occurring slowly over several days.
Briefly differentiate between lactose intolerance, cow’s milk intolerance and cow’s milk protein allergy
This is different to lactose intolerance and cow’s milk intolerance. People with cow’s milk protein allergy do not have an allergy to lactose. Lactose is a sugar, not a protein. Cow’s milk intolerance is not an allergic process and does not involve the immune system.
Who is commonly affected by cow’s milk protein allergy?
Cow’s milk protein allergy is more common in formula fed babies and those with a personal or family history of other atopic conditions.
What are the gastrointestinal features of cow’s milk protein allergy?
Cow’s milk protein allergy usually presents before 1 year of age. It may become apparent when weaned from breast milk to formula milk or food containing milk. It can present in breastfed babies when the mother is consuming dairy products.
Gastrointestinal symptoms:
- Bloating and wind
- Abdominal pain
- Diarrhoea
- Vomiting
What are the allergic features of cow’s milk protein allergy?
Cow’s milk protein allergy usually presents before 1 year of age. It may become apparent when weaned from breast milk to formula milk or food containing milk. It can present in breastfed babies when the mother is consuming dairy products.
General allergic symptoms in response to the cow’s milk protein:
- Urticarial rash (hives)
- Angio-oedema (facial swelling)
- Cough or wheeze
- Sneezing
- Watery eyes
- Eczema
Rarely in severe cases anaphylaxis can occur.
Briefly describe the diagnosis of cow’s milk protein allergy
The diagnosis is made based on a full history and examination. Skin prick testing can help support the diagnosis but is not always necessary.
Briefly describe the management of cow’s milk protein allergy
Avoiding cow’s milk should fully resolve symptoms:
- Breast feeding mothers should avoid dairy products
- Replace formula with special hydrolysed formulas designed for cow’s milk allergy
Why can infants with cow’s milk protein allergy tolerate hydrolysed formula?
Hydrolysed formulas contain cow’s milk, however the proteins have been broken down so that they no longer trigger an immune response. In severe cases infants may require elemental formulas made of basic amino acids (e.g. neocate).
At what age do most children out grow cow’s milk protein allergy?
Most children will outgrow cow’s milk protein allergy by age 3, often earlier.
Briefly describe the use of the milk ladder
Every 6 months or so, infants can be tried on the first step of the milk ladder (e.g. malted milk biscuits) and then slowly progress up the ladder until they develop symptoms. Over time they should gradually be able to progress towards a normal diet containing milk.
Briefly differentiate between cow’s milk intolerance and cow’s milk allergy
Cow’s milk intolerance is different from cow’s milk protein allergy. It is important not to get these mixed up. Cow’s milk intolerance presents with the same gastrointestinal symptoms as cow’s milk allergy (bloating, wind, diarrhoea and vomiting), however it does not give the allergic features (rash, angio-oedema, sneezing and coughing).
Infants with cow’s milk allergy will not be able to tolerate cow’s milk at all, as it causes an allergic reaction, whereas infants with cow’s milk intolerance will be able to tolerate and continue to grow and develop, but will suffer with gastrointestinal symptoms whilst having cow’s milk.
Infants with cow’s milk intolerance will grow out of it by 2 – 3 years. They can be fed with breast milk, hydrolysed formulas and weaned to foods not containing cow’s milk. After one yearof age they can be started on the milk ladder.
