Milk Formula protein intolerance or allergy tutorial Flashcards
Typical presentation of cow’s milk protein Intolerance/Allergy?
baby starts formula feeding at 3 months, starts regurgitation, vomiting, diarrhoea, stops putting on weight.
Cause of cow’s milk protein Intolerance/Allergy?
allergic reaction to cow milk, oft IgE mediated
main features of cow’s milk protein Intolerance/Allergy?
-4
starts regurgitation, vomiting, diarrhoea, stops putting on weight.
other signs of cow’s milk protein Intolerance/Allergy?
-7
wheeze cough urticaria eczema back arching, bring legs up blood in stool
what is back arching a sign of?
reflux
what is bringing legs up sign of?
sign of colicky pain in abdomen
why can there be blood in stool?
colitis
what is an easy non-invasive way to check if it is cow’s milk protein causing the symptoms?
what is this method called?
eliminate milk protein and then it improves
Elimination Diet
how long do you try elimination diet for?
2-4weeks
what blood test can you do to investigate?
total IgE test for cow milk protein
are the allergies always IgE mediated?
no
what Ix is used in children to check for allergies generally (and could be done for cow milk allergy aswell)?
skin prick/patch testing
how does skin prick/patch testing work?
just use needle to prick skin with small amount of allergen – if it reacts (rash, urticaria) you have allergy
category of diagnosis for cow milk allergy/intolerance?
clinical
mainstay 1st line Mx for cow’s milk protein Intolerance/Allergy?
try extensive hydrolysed formula (eHF)
if severe symptoms what is mainstay Mx?
amino-acid based formula (AAF)
2nd line option if eHF has not worked?
amino-acid based formula (AAF)
along with trying new milk is child has failure to thrive what do you do?
refer to paediatrician
mainstay 1st line Mx for soya milk allergy?
extensive hydrolysed formula (eHF) again
usual prognosis for cow’s milk protein Intolerance/Allergy?
eventually start tolerating milk, by age 2-3
what is the difference between IgE mediated and non-IgE mediated reaction in term of time till onset?
IgE = quicker, within a few hours
can you get a cow’s milk protein reaction in an exclusively breastfeeding mother?
yes
why can you get a cow’s milk protein reaction in an exclusively breastfeeding mother?
cow protein can enter through breast milk
how rare is a cow’s milk protein reaction in an exclusively breastfeeding mother?
are symptoms mild or severe?
very rare
symptoms much milder
Mx for a cow’s milk protein reaction in an exclusively breastfeeding mother?
(what do you tell mum to do)
-3
mum needs to:
stop drinking cow milk
take Ca2+ & Vit D supplement
Skin prick test only works on what type of allergies?
IgE mediated ones
why is rice milk not recommended?
contains arsenic
why is goat milk not recommended?
another mammalian milk so will probs be allergic to this also
why is almond milk not recommended?
might not have allergy but does not have nutrition the baby needs
