COW’S MILK PROTEIN INTOLERANCE (Allergy)
Definition
Immune-mediated allergic response to milk proteins.
Types
a) Immunoglobulin E (IgE)-mediated. It has following characteristics
- Acute and rapid onset.
- Up to 2 hours after ingestion of cows’ milk.
- 50% children become milk tolerant by 5 years.
b) Non-IgE-mediated reactions. It has following characteristics-
- Delayed and non-acute allergic response.
- Can occur up to 48 hours or even 1 week after ingestion.
- Most children become milk tolerant by 3 to 4 years.
SYMPTOMS
a) Skin reactions
- Pruritus/ Erythema
- Atopic eczema
- Acute angioedema
b) Gastrointestinal symptoms
- Nausea/ Vomiting
- Colicky abdominal pain
- Diarrhoea/ Blood in stool
- Reflux / Constipation.
c) Respiratory tract symptoms
- Cough/ wheezing
- Nasal itching/ sneezing/ rhinorrhoea
d) Failure to thrive
DIFFERENTIAL DIAGNOSIS-
- Lactose intolerance
- Other food allergies- (hens’ eggs, soy, wheat)
- Anatomical abnormalities (Meckel’s diverticulum).
- Gastro-oesophageal reflux disease
- Crohn’s disease / Coeliac disease/ Ulcerative colitis
- Constipation/ Gastroenteritis
- Pancreatic insufficiency ( cystic fibrosis).
- Infections (urinary tract infections)
DIAGNOSIS
- Clinical examination.
- Trial elimination of cow’s’ milk for 2–6 weeks, followed by reintroduction
- Skin prick test (Positive only in IgE mediated reactions)
- Blood tests for antibody levels to milk proteins.
MANAGEMENT
In Exclusively breastfed babies –
- Mother to exclude cow’s’ milk protein from her diet.
- Supplement 1000 mg of calcium + 10 micrograms of vitamin D to mother on daily basis.
In formula-fed babies-
Use hypoallergenic formula
Treat for at least 3 weeks to see improvement.
Names of common hypoallergenic formulas are as below-
a) Extensively hydrolysed formulas ( 1st line of treatment).
- Alimentum— can be given from birth
- Aptamil Pepti 1 — can be given from birth
- Aptamil Pepti 2—given from 6 months of age
- Cow & Gate PeptiJunior — given from birth
- Nutramigen Lipil 1 — given from birth
- Nutramigen Lipil 2 – given from 6 months of age
- Pregestimil Lipil— given from birth
b) Amino acid formulas – the Second line of treatment.
These are more expensive than hydrolysed formulas.
- Neocate LCP — given from birth
- Neocate Active — given from 1 year of age
- Neocate Advance — given from 1 year of age for children who cannot eat any other foods
- Nutramigen Puramino — given from birth