Immunology - Cow's Milk Protein Allergy Flashcards
What age are children typically affected by Cow’s milk protein allergy?
Infants and children under 3
What is the difference between IgE and non-IgE mediated reactions to the protein in cow’s milk?
IgE mediated
Rapid reaction within 2 hours
Non-IgE mediated
Slowly over several days
What is the difference to CMPA and lactose intolerance?
CMPA do not have allergy to lactose, but to the proteins in cow’s milk
Lactose is a sugar
When is CMPA more common?
Formula fed babies
Personal or family history of atopic conditions
When does CMPA present?
Before 1 years old usually
May become more apparent when weaned from breast milk to formula milk
Can present in breastfed babies if mother consuming dairy products
What symptoms does CMPA present with?
GI
- Bloating and wind
- Abdominal pain
- Diarrhoea
- Vomiting
General allergic symptoms
- Urticarial rash
- Angio-oedema
- Cough or wheeze
- Sneezing
- Watery eyes
- Eczema
Rarely anaphylaxis
How is CMPA diagnosed?
Full history and examination
Skin prick testing can support diagnosis but not always necessary
How is CMPA managed?
Avoiding cow’s milk should fully resolve symptoms
- Breast feeding mothers should avoid dairy products
- Replace formula with hydrolysed formulas designed for cow’s milk allergy
Why do hydrolysed formulas not cause a reaction?
Contains cow’s milk but proteins have been broken down, so no longer trigger an immune response
In severe cases infants may need elemental formulas, made of basic amino acids e.g. neocate
When do most kids outgrow CMPA?
Age 3, often earlier
How often can kids be tried on a different step of the milk ladder?
Every 6 months they can slowly progress until they develop symptoms
Over time can progress to normal diet with milk
What is the difference between cow’s milk intolerance and cow’s milk allergy?
Intolerance
Presents with same GI symptoms, however, No allergic features
Infant’s with CMA cannot tolerate cow’s milk at all, intolerance can tolerate it and continue to grow and develop but suffer with GI symptoms
When do infants with CM intolerance grow out of it?
2-3 years old
What can infants CM intolerance be given?
Breast milk
Hydrolysed formulas
Weaned to foods not with cow’s milk
After one year of age can be started on the milk ladder
