Milk Allergy or Intolerance
COW’S MILK ALLERGY
Cow's milk allergy is the most common food allergy in young children. Fortunately, most babies outgrow milk allergies by their second or third year. Cow’s milk allergy is caused by the milk protein in cow's milk allergy. Cow's milk protein allergy can develop in both breastfed and formula-fed children although studies show that breastfed children are less likely to develop any form of food allergy.
Symptoms can be sudden, including wheezing, swelling of the throat, hives, other itchy bumps on the skin, and bloody diarrhea. Very rarely children may have a severe anaphylactic reaction. Slower-onset reactions are much more common. These symptoms may include loose stools (possibly containing blood), vomiting, gagging, refusing food, irritability or colic, and skin rashes. Slow onset reactions are more difficult to diagnose because the same symptoms may occur with other health conditions.
Accurate diagnosis of cow’s milk allergy is vital as removing cow’s milk from a child’s diet will affect their nutritional intake. A baby with a suspected milk allergy should have an individualized medical assessment, treatment plan, and follow up. A doctor should review the child's medical history and recommend any appropriate modifications to a child’s diet or any specific milk formulas that may be required. In some mild cases, the doctor may recommend re-introducing milk after a few months of following a milk-free diet to see if the child still has symptoms of milk allergy. In other cases, the doctor may refer the child to an allergy clinic. Here further investigations may take place including skin tests or blood test to detect IgE that is involved in immediate allergic reactions.
How is a cow's milk allergy treated?
Cow’s milk allergy is treated through a milk free diet. This diet should be undertaken with the supervision of a dietitian, who will provide milk-free recipes and a list of alternative products to ensure a nutritionally adequate diet. This is necessary to avoid nutrient deficiency specifically of calcium, riboflavin and vitamin D. All pregnant and breast-feeding mothers, children and adults on a dairy-free diet, must have their calcium replaced; otherwise this could lead to dental and bone problems (osteoporosis). The type and dosage of calcium supplement can be advised by the doctor and dietitian.
Whilst it is relatively easy to recognise the major sources of milk protein such as cow’s milk, yoghurt and cheese, it is much harder to identify manufactured products that contain milk. For example sausages, fish fingers, pie crusts, biscuits and breakfast cereals may all contain milk. People with cow’s milk allergies must be given thorough advice to help identify milk from food labels and milk free lists or diet sheets. If a child has been diagnosed with a severe milk allergy, the doctor may prescribe special medications in addition to a dairy-free diet such as antihistamines or epinephrine (Epipen or Ana-kit).
MILK PROTEIN INTOLERANCE
Milk protein intolerance is a delayed reaction to milk protein. In contrast to milk allergy, milk protein intolerance produces a non-IgE antibody and is not detected by allergy blood tests.
Milk protein intolerance produces a range of symptoms including eczema, vomiting, diarrhea, and stomach cramps, but not hives or breathing problems (symptoms of milk allergy). Children who have milk intolerance often grow out of it by the time they go to school.
Treatment for milk protein intolerance is the same as for milk allergy i.e. the avoidance of milk protein in the diet. Please refer to the previous section for advice and implications
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