Milk Formula protein intolerance or allergy tutorial

Question 1

Typical presentation of cow’s milk protein Intolerance/Allergy?

Answer 1

baby starts formula feeding at 3 months, starts regurgitation, vomiting, diarrhoea, stops putting on weight.

Question 2

Cause of cow’s milk protein Intolerance/Allergy?

Answer 2

allergic reaction to cow milk, oft IgE mediated

Question 3

main features of cow’s milk protein Intolerance/Allergy?

-4

Answer 3

starts regurgitation, vomiting, diarrhoea, stops putting on weight.

Question 4

other signs of cow’s milk protein Intolerance/Allergy?

-7

Answer 4

wheeze
cough
urticaria
eczema
back arching, bring legs up
blood in stool

Question 5

what is back arching a sign of?

Answer 5

reflux

Question 6

what is bringing legs up sign of?

Answer 6

sign of colicky pain in abdomen

Question 7

why can there be blood in stool?

Answer 7

colitis

Question 8

what is an easy non-invasive way to check if it is cow’s milk protein causing the symptoms?

what is this method called?

Answer 8

eliminate milk protein and then it improves

Elimination Diet

Question 9

how long do you try elimination diet for?

Answer 9

2-4weeks

Question 10

what blood test can you do to investigate?

Answer 10

total IgE test for cow milk protein

Question 11

are the allergies always IgE mediated?

Answer 11

no

Question 12

what Ix is used in children to check for allergies generally (and could be done for cow milk allergy aswell)?

Answer 12

skin prick/patch testing

Question 13

how does skin prick/patch testing work?

Answer 13

just use needle to prick skin with small amount of allergen – if it reacts (rash, urticaria) you have allergy

Question 14

category of diagnosis for cow milk allergy/intolerance?

Answer 14

clinical

Question 15

mainstay 1st line Mx for cow’s milk protein Intolerance/Allergy?

Answer 15

try extensive hydrolysed formula (eHF)

Question 16

if severe symptoms what is mainstay Mx?

Answer 16

amino-acid based formula (AAF)

Question 17

2nd line option if eHF has not worked?

Answer 17

amino-acid based formula (AAF)

Question 18

along with trying new milk is child has failure to thrive what do you do?

Answer 18

refer to paediatrician

Question 19

mainstay 1st line Mx for soya milk allergy?

Answer 19

extensive hydrolysed formula (eHF) again

Question 20

usual prognosis for cow’s milk protein Intolerance/Allergy?

Answer 20

eventually start tolerating milk, by age 2-3

Question 21

what is the difference between IgE mediated and non-IgE mediated reaction in term of time till onset?

Answer 21

IgE = quicker, within a few hours

Question 22

can you get a cow’s milk protein reaction in an exclusively breastfeeding mother?

Answer 22

yes

Question 23

why can you get a cow’s milk protein reaction in an exclusively breastfeeding mother?

Answer 23

cow protein can enter through breast milk

Question 24

how rare is a cow’s milk protein reaction in an exclusively breastfeeding mother?

are symptoms mild or severe?

Answer 24

very rare

symptoms much milder

Question 25

Mx for a cow’s milk protein reaction in an exclusively breastfeeding mother?
(what do you tell mum to do)
-3

Answer 25

mum needs to:
stop drinking cow milk
take Ca2+ & Vit D supplement

Question 26

Skin prick test only works on what type of allergies?

Answer 26

IgE mediated ones

Question 27

why is rice milk not recommended?

Answer 27

contains arsenic

Question 28

why is goat milk not recommended?

Answer 28

another mammalian milk so will probs be allergic to this also

Question 29

why is almond milk not recommended?

Answer 29

might not have allergy but does not have nutrition the baby needs