Cow's milk protein allergy

Question 1

What is Cow’s milk protein allergy?

Answer 1

Hypersensitivity to the protein in cow’s milk

Question 2

What cow’s milk proteins can children be allergic to?

Answer 2

Caesin, whey

Question 3

What are the different types of cow’s milk protein allergy?

Answer 3

IgE mediated and non-IgE mediated

Question 4

How do IgE mediated and non-IgE mediated cow’s milk protein allergy present differently?

Answer 4

IgE mediated - quick onset (2 hours) after ingestion
Non-IgE mediated - reaction occurs over several hours

Question 5

What are the gastrointestinal symptoms of cow’s milk protein allergy?

Answer 5

Bloating and wind
Abdominal pain
Diarrhoea
Vomiting

Question 6

What other symptoms can occur in cow’s milk protein allergy?

Answer 6

Angioedema of the face, lips, eyes
Wheeze
Itching
Urticarial rash
Cough
Eczema
Watery eyes

Question 7

What is the epidemiology of cow’s milk protein allergy?

Answer 7

Generally occurs in under 1 year old

Question 8

What are the risk factors for cow’s milk protein allergy?

Answer 8

Personal history of atopy
Family history of atopy
Formula feeding

Question 9

What are the differentials of cow’s milk protein allergy?

Answer 9

Food allergy or intolerance
Meckel’s diverticulum
GORD
Coeliac disease
Gastroenteritis
Pancreatic insufficiency

Question 10

What investigations can be used to diagnose cow’s milk protein allergy?

Answer 10

IgE antigens to cow’s milk protein
- Skin prick testing

Question 11

What is the management of cow’s milk protein allergy?

Answer 11

Avoidance of cow’s milk proteins:
- Continue breast feeding and avoid maternal cow’s milk consumption
- Extensively hydrolysed formula feeds
- Amino acid based formula