Milk allergy

Milk allergy
Specialty	Allergology

Milk allergy is a food allergy immune adverse reaction to one or more of the proteins in cow's milk .

Symptoms

The principal symptoms are gastrointestinal, dermatological and respiratory. These can translate to: skin rash, hives, vomiting, diarrhea, constipation and distress. The clinical spectrum extends to diverse disorders: anaphylactic reactions, atopic dermatitis, wheeze, infantile colic, gastroesophageal reflux (GER), oesophagitis, allergic colitis and constipation.

The symptoms may occur within a few minutes after exposure in immediate reactions, or after hours (and in some cases after several days) in delayed reactions.

Difference between milk allergy and lactose intolerance

Milk allergy is a food allergy, an adverse immune reaction to a food protein that is normally harmless to the non-allergic individual. Lactose intolerance is a non-allergic food sensitivity, and comes from a lack of production of the enzyme lactase, required to digest the predominant sugar in milk. Lactose intolerance is not actually a disease or malady. Adverse effects of lactose intolerance occur at much higher milk consumption than adverse effects of milk allergy.

Difference from milk protein intolerance

Milk protein intolerance (MPI) is delayed reaction to a food protein that is normally harmless to the non-allergic, non-intolerant individual. Milk protein intolerance produces a non-IgE antibody and is not detected by allergy blood tests. Milk protein intolerance produces a range of symptoms very similar to milk allergy symptoms, but can also include blood and/or mucus in the stool. Treatment for milk protein intolerance is the same as for milk allergy. Milk protein intolerance is also referred to as milk soy protein intolerance (MSPI).

Treatment

Currently the only treatment for milk allergies is total avoidance of milk proteins. Products in addition to milk itself to be avoided by those with milk allergy include yogurt, butter, cheese, and cream. Goats' milk products may also need to be avoided.

Ingredients that also denote that food product contains dairy milk include whey, casein, caseinate, butter flavor, lactic acid (lactic acid derived from dairy products), natural or artificial flavors such as milk or butter flavor, and sodium caseinate.

It is commonplace for milk or milk derivatives to be included in processed foods such as bread, crackers, cookies, cakes, prepared meats, "soy cheese", soups, gravies, potato chips, margarine, and products labeled "non-dairy", such as whipped topping and creamer (non-dairy simply means less than 0.5% milk by weight)

Also, many processed foods that do not contain milk may be processed on equipment contaminated with dairy foods, which may cause an allergic reaction in some sensitive individuals.

Milk Avoidance and Replacement For Infants

Since milk protein may be transferred from a breastfeeding mother to an allergic infant, lactating mothers are given an elimination diet. For formula fed infants, milk substitute formulas are used to provide the infant with a complete source of nutrition. Milk substitutes include soy based formula, hypoallergenic formulas based on partially or extensively hydrolyzed protein (such as nutramigen, alimentum, and pregestemil) or free amino acids (such as neocate). Partially hydrolysates formula are characterised by a larger proportion of long chains (peptides) and are considered more palatable. However, they are intended for prophylactic use and are not considered suitable for treatment of milk allergy/intolerance. Extensively hydrolysed proteins comprise predominantly of free amino acids and short peptides. Casein and whey are the most commonly used sources of protein for hydrolysates because of their high nutritional quality and their amino acid composition. Non-milk derived amino acid-based formulas are suitable for the treatment of both mild-moderate and severe milk allergy, if allergic infants don’t respond to protein hydrolysate formulas. Soy based formula does have a risk of allergic sensitivity, as some infants who are allergic to milk may also be allergic to soy.

Milk Substitution for Children and Adults

There are many commercially available replacements for milk for children and adults - Rice milk, soy milk, oat milk and almond milk are also sometimes used as milk substitutes, but are not suitable nutrition for infants. Fruit juices supplemented with calcium which may provide an alternative for adults and children. If on an avoidance diet, it is important that dietary advice is taken as a replacement source of calcium may need to be found to prevent the longer term risk of calcium deficiency and osteoporosis.

Accidental Exposure Treatment for accidental ingestion of milk products by allergic individuals varies depending on the sensitivity of the allergic person. Frequently medications such as an Epinephrine pen or an Antihistamine such as Diphenhydramine (Benadryl) are prescribed by an allergist in case of accidental ingestion. Milk allergy can cause anaphylaxis, a severe, life threatening allergic reaction.

Like many food allergies milk allergy may be outgrown eventually by children, although a percentage of children do not outgrow their allergy.(see below) Milk allergy is more likely to be outgrown than peanut allergy.

Vaccines

Some vaccines contain casamino acid, derived from bovine casein, as the growth medium. Casamino acid is a mixture of amino acids derived from the hydrolysis of casein, used as a supplement in the growth media. The FDA does not require allergen labeling on medications or vaccines and most doctors are unaware of this ingredient. Extreme caution must be taken to prevent a serious or life threatening reaction.

Statistics

Milk allergy is the most common food allergy in early childhood. It affects somewhere between 2% and 3% of infants in developed countries, but approximately 85-90% of affected children lose clinical reactivity to milk once they surpass 3 years of age.

Between 13% and 20% of children allergic to milk are also allergic to beef.

See also

• Dairy product

External links

• Milk Allergy information page. Asthma and Allergy Foundation of America
• Eating without CaseinPractical guide to milk-free eating
• Milk Allergy More Persistent Disease
• Milk Allergy at Food Allergy Initiative