How to get rid of cow milk allergy?

Persistent milk allergy can be treated with oral immunotherapy (OIT) in patients of all ages. Historically patients with milk allergies have been guided to avoid all dairy products.

Is a dairy allergy the same as being lactose intolerant?

Lactose intolerance is different from milk or dairy allergy . With a dairy allergy, an immune reaction leads to swelling, breathing problems, and anaphylaxis. Lactose intolerance is an inability to digest the sugars in milk products. It causes intestinal symptoms, such as bloating and diarrhea.

Can I be allergic to milk but not cheese?

Can you be allergic to milk but not cheese? Most people with milk allergy will not be able to eat cheese made with cow's milk or other milk from mammals (goat, sheep, etc.). However, they may be able to eat some non-dairy or vegan cheeses.

How can I tell if I'm allergic to milk?

Symptoms include stomach problems, itching, rash and tingling around your mouth. A severe milk allergy may cause anaphylaxis. An allergist can diagnose a milk allergy through testing. Treatment includes medications and avoiding products that contain milk.

What does baby poop look like with a milk allergy?

Your baby may experience frequent watery, foul-smelling loose poops if they have a cow's milk protein allergy. You may also notice mucus in the stool, and your little one may be gassy and colicky. Babies with diarrhea may quickly become dehydrated, so calling your doctor is recommended.

Can you suddenly develop a milk allergy?

The sudden development of an allergy to cow's milk as an adult can happen but is very rare and as a result there has been little research carried out about it and why it might occur.

What happens if you ignore lactose intolerance?

For those who suffer, ignoring symptoms can lead to enhanced stomach issues, chronic diarrhea, and additional health problems . For example, the development of chronic diarrhea can lead to anemia, dehydration, and kidney damage, among other serious concerns.

How can I tell if I'm lactose intolerant?

Symptoms of Lactose Intolerance If your body can't digest lactose-containing dairy products, you can experience unpleasant side effects, including abdominal pain, bloating, cramps, flatulence, nausea and diarrhea . These symptoms normally start within 30 minutes to two hours after consuming lactose.

Can I eat butter if I am allergic to milk?

Even though butter contains almost no protein, even trace amounts can cause a reaction. This means it should not be considered safe for people with a milk protein allergy . Butter is made from milk, making it a dairy product. However, it's allowed on some dairy-free diets because it's low in protein and carbs.

How to flush dairy out of your system quickly?

A: To flush dairy out of your system quickly, eliminate all dairy products from your diet and load up on vegetables, fruits, whole grains, legumes, and seeds . These are high in fiber and acids that help break down and push out all milk proteins from your system. Also, set aside some time to work out.

Can you develop a cows milk allergy later in life?

The sudden development of an allergy to cow's milk as an adult can happen but is very rare and as a result there has been little research carried out about it and why it might occur.

What is a delayed reaction to cow's milk?

Delayed type CMPA reactions were defined as non-IgE or mixed-type reactions that occur 6–48 hours after ingestion . These include both gastrointestinal or cutaneous symptoms that improve with exclusion and reappear with reintroduction of cow's milk.

Cow Milk Allergy (2024)

Continuing Education Activity

Cow's milk allergy is an allergic reaction to the protein found in cow’s milk. Diagnosis can be difficult as it is primarily based on history and physical exam. This activity outlines the evaluation and management of cow's milk allergy and highlights the role of the interprofessional team in managing patients with this condition.

Objectives:

Identify the pathophysiology of cow's milk allergy.
Describe the typical history and physical findings in patients with a cow's milk allergy.
Describe the treatment and management options available for cow's milk allergy.
Summarize the importance of coordination among interprofessional teams to improve the care of children diagnosed with a cow's milk allergy.

Access free multiple choice questions on this topic.

Introduction

Cow's milk allergy is a common diagnosis in infants and children. It characteristically presents as an allergic reaction to the protein found in cow’s milk. Cow's milk allergy manifests as a variety of symptoms and signs which commonly develop in infants and can regress by the age of 6. It can be a source of parental and family stress due to a milk-free diet and can lead to a subsequent nutritional deficiency if not treated appropriately.

Etiology

Food allergies stem from the host's immune system. If an individual has an allergy to milk, the body’s immune system responds to a specific milk protein, triggers an immune response, and attempts to neutralize the triggering protein. The next time that the body comes into contact with the protein, the immune response recognizes the protein. It triggers the immune system to mount a response, including the release of histamine and other immune mediators. This release of chemicals causes the signs and symptoms of cow's milk allergy.

Epidemiology

It is difficult to determine the exact prevalence of cow's milk allergy due to a lack of a precise criterion for diagnosis. Often the term allergy is interchanged with intolerance or hypersensitivity. In the developed world, the prevalence appears to be 2 to 3% in infants.[1]There is no evidence that prevalence is increasing, and parents perceive cow's milk allergy more frequently than can be proven with an oral challenge.[2][3]By the age of 6, the prevalence has fallen to less than 1%.[4]

Pathophysiology

Cow's milk contains more than 20 protein fractions. The significant allergens belong to casein protein (alpha-s1-, alpha-s2-, beta-, and kappa-casein) and whey proteins (alpha-lactalbumin and beta-lactoglobulin).[5]Most individuals with cow's milk allergies have a sensitivity to both caseins and whey proteins.[6] Immune-mediated adverse food reactions classify intotwo primary categories: IgE-mediated, non-IgE-mediated. A non-IgE mediated mechanism most frequently causes cow's milk allergy.[7]

History and Physical

Typically the presence of cow's milk allergy appears within the first few months of life and usually before six months. Symptoms can present a few days or weeks after the ingestion of cow’s milk protein. The symptoms can vary from diarrhea and emesis to life-threatening anaphylaxis. In cases that involve the GI tract, the child can become dehydrated and exhibit a failure to thrive.

Cow's milk allergy reactions classify into rapid onset; usually, IgE mediated, where symptoms occur within an hour after ingestion, and slow onset, non-IgE mediated, where symptoms take hours or days to present.[8][9]

Rapid onset symptoms can include:

Urticaria/hives
Wheezing
Itching or a tingling feeling around the mouth or lips
Angioedema: swelling of the lips, tongue, or throat
Coughing or shortness of breath
Vomiting
Anaphylaxis

Slow onset symptoms can include:

Diarrhea
Hematochezia
See Also
What Your Baby’s Poop Can Say About Milk Protein Allergies Milk Allergy Baby Poop: What Does it Look Like? | Enfamil Milk
Abdominal cramps
Colic

Anaphylaxis is a medical emergency requiring treatment with an epinephrine shot and evaluation in the emergency room. Signs and symptoms start soon after milk consumption and can include:

Increased work of breathing
Constriction of airways
Swollen throat
Facial flushing
Itching

The clinician must recognize the difference between milk allergy and milk intolerance. The major difference is that intolerance does not involve the immune system. Common symptoms of milk intolerance include gas, bloating, or diarrhea after ingesting milk. The treatment of intolerances and allergies is different.[10]

Evaluation

There is no specific test to detect cow's milk allergy. The basis of diagnosis is primarily on the history of symptoms and physical exam. It is important to detail the timeline of symptoms and when they occur. Carrying out a diagnostic protocol in infants for suspected cow's milk allergy may help to rule in or out the disease.[11]

Primary tests, if used, include a skin prick test and serum-specific IgE. Both tests show high sensitivity but low specificity and can be positive in non-allergic subjects.[12]

Serum-specific IgE to cow’s milk allergy: This can aid in the diagnosis of IgE mediated cow's milk allergy and cut-off values are multifactorial and should be set by each allergist.[13]

Skin prick test: This is performable by an allergy specialist.

Diet elimination: If suspected, an infant should receive a diet free of cow's milk protein for a month. If symptoms improve following elimination of the suspected food, then an oral food challenge is the gold standard test.[14] This challenge must be in a medical setting due to concern for systemic IgE mediated reaction. Patients should undergo reevaluation every 6 to 12 months to determine if they have developed a tolerance to cow's milk protein.[15]

Algorithm:

1: If there are signs of anaphylaxis or immediate reaction, then diet elimination is recommended, and testing for serum IgE should follow. If serum-specific IgE is positive, then the child is diagnosed with a cow's milk allergy. If IgE is negative and symptoms improve after diet elimination, an oral challenge should be next. If the symptoms reoccur, the diagnosis is confirmed. If the symptoms do not reoccur, then the diagnosis of cow's milk allergy is excluded.[9]

2: If the symptoms are not consistent with anaphylaxis or immediate reaction, then an elimination diet is recommended. If symptoms improve, then an oral challenge should be done, and if symptoms reoccur, the diagnosis is confirmed. If the symptoms do not reoccur, it excludes the diagnosis of cow's milk allergy.[16][9]

3: If symptoms do not improve after the elimination diet, this eliminates the diagnosis of cow's milk allergy, and further evaluation should be done to assess the patient.[9]

Treatment / Management

The definitive treatment for all food allergies is the strict elimination of the food from the diet. If a child starts on a milk-free diet, the doctor or dietitian can help plan nutritionally balanced meals. The parent or child may need to take supplements to replace calcium and nutrients found in milk, such as vitamin D and riboflavin.[15]

Breastfeeding: Rates of cow's milk allergy in breastfeeding infants is lower than formula-fed infants and have been reported to be about 0.5%.[17] Breastfeeding is recommended, particularly if the infant is at high risk of developing milk allergy. Cow's milk proteins passed through breastmilk to the child and may cause an allergic reaction. If the child has a cow's milk allergy, then the mother should eliminate all foods containing cow's milk protein, including cheese, yogurt, and butter from her diet.[9]

Hypoallergenic formulas: These formulas are hydrolyzed via enzymes to break down the milk proteins. Depending on their processing level, products are classified as either partially or extensively hydrolyzed/elemental formulas. Recommendations are for extensively hydrolyzed formulas due to increased allergenicity and associated reactions in partially hydrolyzed formulas.[18]

Soy-based formulas: As many as 50% of children affected by cow's milk protein intolerance also develop soy protein intolerance if fed with soy-based formulas. Therefore, soy-based formulas are not generally a viable option for the treatment of cow's milk protein intolerance.[15][7]

Alternative milk: substitutes such as sheep’s and goat’s milk generally are not acceptable because of a high degree of cross-reactivity with cow's milk protein.However, research shows that there have been decreased incidents of cross-reactivity to camel’s milk.[19]

Acute treatment:

Despite the parent's best efforts, if achild accidentally consumes milk, medications such as antihistamines may reduce the mild allergic reaction.

If the parent or child has a serious allergic reaction, they may require an emergency epinephrine injection and a visit to the emergency room. If there is a risk of having a severe reaction, the parent or child may need to carry injectable epinephrine at all times. These individuals should have their doctor or pharmacist demonstrate how to use this device so that they are prepared for an emergency.[20][21]

Differential Diagnosis

Due to a wide variety of symptoms that can be caused by cow's milk allergy, the differential diagnosis can be extensive and include but not limited to:

Other food allergies
Celiac disease
Enteropathy
GI infections
Enterocolitis
Inflammatory bowel disease
Meckel diverticulum
Angioedema
Lactose intolerance
Idiopathic urticaria
Anaphylaxis

Prognosis

The prognosis for cow's milk protein allergy in infancy and youngchildhood is good. Approximately 50% of affected children developtolerance by the age of 1 year, more than 75% by the age of 3 years, and over 90%are tolerant at 6 years of age.[4][22]

Children who display an allergy to milk are more likely to develop other allergies to foods. Associated adverse reactions to different foods develop in up to 50% of children, and allergies against inhalants occur in 50% to 80% before puberty.[23]

Pearls and Other Issues

Cow's milk allergy is a common diagnosis in infants and children.
It is difficult to detect the exact prevalence of cow's milk allergy due to a lack of a precise criterion to diagnose.
It can be classified into two major categories: IgE-mediated, non-IgE-mediated.
Typically the presence of cow's milk allergy appears within the first few months of life and usually before six months.
The clinician must recognize the difference between milk allergy and milk intolerance.
The basis of diagnosis is primarily on the history of symptoms and physical exam.
The definitive treatment for all food allergies is the strict elimination of the food from the diet.

Enhancing Healthcare Team Outcomes

The majority of children with cow's milk allergy are first seen by the primary caregivers including the pediatrician, family physician, and nurse practitioner. In most cases, avoidance of milk can solve the problem but since milk products are ubiquitous, the risk of an allergy cannot always be eliminated. Patients with continued allergies need to be referred to a specialist.

An allergist is best to diagnose a cow's milk allergy, but usually, the primary care provider will handle long-term care and monitoring. The patient and family should receive counseling and education on the medical condition and the importance of avoidance of foods containing cow’s milk protein. Parents need to be educated by the primary clinicians that cow's milk allergy can be a medical emergency, and if there is a history of rapid reaction or anaphylaxis, then epinephrine should be carried at all times.

Cow's milk allergy requires an interprofessional team approach, including physicians, specialists (most notably an allergist), specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. The family may be educated by the pediatric nurse, who provides updates to the rest of the team. Pharmacists may be involved in formula selection and assist in medication review. [Level 5]

Review Questions

References

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: Disclosure: Christopher Edwards declares no relevant financial relationships with ineligible companies.
: Disclosure: Mohammad Younus declares no relevant financial relationships with ineligible companies.