Cow's Milk Protein/Lactose Intolerance Flashcards
What is cow’s milk protein present in: breast or formula milk?
Both.
Common clinical features of CMP intolerance
- Frequent regurgitation
- Vomiting (large volume, usually > 3times per day)
- Diarrhoea
- Constipation
- Blood in stool
- Iron-deficiency anaemia
- Atopic dermatitis
- Angio-oedema
- Coryzal symptoms
- Persistent distress or colic
Rare clinical features of CMP intolerance
- Failure to thrive
- Refusal to feed
- Exudative or severe atopic dermatitis
- Acute laryngoedema
- Anaphylaxis
How do you Dx CMP intolerance?
Clinically by food challenge, either by:
- trial of eliminating cow milk by modifying the mother’s diet
- changing to an extensively hydrolysed formula for a period of 2 weeks
How can you confirm CMP allergy resolution?
Confirmed by skin testing and food challenge with milk:
• Food challenge: can either eliminate cow milk from mother’s diet or change to extensive hydrolysed formulas for 2 weeks
• Doesn’t work for lactose intolerance
Mx of CMP intolerance
Cow’s milk alternatives e.g.:
• Extensively hydrolysed and amino acid based infant formulae (e.g. PeptiJunior, Alfare, Allerpr, Elecare, Neocate)
• Cereal based beverages (e.g. rice milk, oat milk, almond milk)
• Soy infant formulae
- Breastfeeding (maternal dietary exclusion of CMP)
- Require calcium supplement
What is the most common cause of secondary lactose intolerance? What is something you should ask on history to figure this out?
• Functional lactose overload
• Short feeds/frequently switch sides/feed often
○ more lactose present in foremilk, more fat in hindmilk
Features of lactose intolerance
- Stomach pain or bloating
- Diarrhoea esp. ‘frothy, watery diarrhoea’
- Perianal excoriation
- Wind
Dx of lactose intolerance
• faecal reducing substances ≥0.5% and pH < 5.0, and confirmed by clinical response to lactose-free formula
