August 10, 2017

Cow’s Milk Protein Allergy

Milk allergy is considered to be the most common food allergy. The milk allergy affects at least 3% of all children. In some cases children can outgrow milk allergy, but sometimes milk allergy persists into adulthood and can even last a whole life.

Groups of Milk Proteins

Milk proteins that cause allergic reactions can be divided into 2 large groups:

1) Casein, which is 80% of the total protein mass. Casein forms colloidal particles with calcium phosphate, which gives the milk a milky white stain. Its components include alpha and beta-casein components.

2) Whey proteins 20%. They include alpha and beta-lactoglobulins as well as bovine immunoglobulin.

Proteins that most often cause allergic reactions include beta-lactoglobulin in 70% of cases, casein 60%, alpha-lactalbumin 50%, bovine serum albumin 48%, lactoferin 35%. Most children are allergic to several proteins at the same time. 9% of children who are allergic to milk proteins have an allergy to beef proteins. However, half of these children do not react to beef proteins in the event that the meat is well thermally processed.

A higher temperature of meat processing destroys a part of the proteins, therefore some children do not develop an allergic reaction. Milk contains many proteins that are not destroyed under the influence of high temperatures, so the thermal milk processing does not allow to introduce it in the diet of patients with sensitivity to cow’s milk proteins. The development of an allergic reaction can be caused by sensitivity to one or more proteins.

Allergies to the whey components usually are more easily outgrown by children, but allergies to the casein components can persist into adulthood.

General Symptoms of Milk Allergy

Traditionally, the symptoms of milk allergy occur due to the presence of allergic antibody and they are called “IgE mediated”.

The classic symptoms are divided into the following groups:

  • skin symptoms such as pruritus (itching), urticaria (hives), atopic dermatitis (eczema), angioedema (swelling) and other skin rashes
  • gastrointestinal tract (diarrhea, nausea, vomiting) and anaphylaxis
  • respiratory tract (asthma, nasal allergy)

Milk allergy which is not caused by allergic antibody may also appear. These symptoms are caused by the immune system. These non-IgE mediated symptoms of milk allergy are indicative of the food food protein-induced proctitis, protein-induced enterocolitis syndrome (FPIES), and Heiner syndrome.

How to Diagnose Milk Allergy?

To diagnose IgE-mediated milk allergy reactions, it necessary to perform allergy testing such as skin testing or demonstration of IgE against milk protein in blood. The skin testing is the more accurate method to diagnose milk allergy. The non-IgE mediated reactions diagnosis is more difficult to make. Tradionally, the diagnosis is made based on symptoms being present and the lack of allergic antibodies.

Sometimes,  to diagnose FPIES and EoE, patch testing is used. As well, the blood testing for IgG antibodies can be very helpful to diagnose Heiner syndrome.

How to Treat Milk Allergy?

General cow’s milk allergy methods include:

  • The main widely accepted milk allergy treatment is to avoid milk and dairy products.
  • Oral immunotherapy for milk allergy is currently being studied at different world’s medical universities. This therapy involves consuming by people with milk allergy small amounts of milk protein and gradually increasing the amount over time. However, it is important to know that OIT can be very dangerous and it must be performed in university settings under strict medical supervision.
  • Replacing cow’s milk with an infant formula. To replace cow’s milk in the diet of children with allergies to its proteins, infant formulas based on hydrolyzed protein, soy, rice, and milk from other domestic animals can be used. Unfortunately, any of the mentioned products can also cause allergies.
  • Prescription of enterosorbents. They allow quickly removing toxins from the digestive tract that are formed during an allergic reaction. You should remember that sorbents are given only an hour and a half after taking other medications.
  • They relieve respiratory, skin, and food allergy symptoms
  • Hormonal drugs. They are prescribed in the case of strong signs of allergic reaction such as violation of breathing, cardiac activity, and anaphylactic shock.
  • Ointments are used to eliminate skin manifestations.
  • It can help in the treatment of symptoms of milk protein allergy, it is combined with basic therapy and, after removing signs, it is used to strengthen immunity.

How often is the Milk Allergy Outgrown by children?

Most children outgrow their milk allergy, especially those with non-IgE mediated allergy. Studies suggest that 80% of children outgrow the allergy by age 5. If the allergic antibody to milk is below a certain level, a doctor can recommend performing a food challenge to milk under strong medical supervision. This is the only way to see if a person has outgrown the milk allergy.


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