Milk allergy

Milk allergy is thought by some people to be an immunologically mediated adverse reaction to one or more cow's milk proteins. It should noted that there are different types of milk, and most of the information in this page relates to the consumption of conventional milk from grain fed confined cattle. Milk from organic grass-fed pasturing cattle actually reduces allergies and promotes good health.

In some people the ingestion of cow's milk can trigger the body into launching an inappropriate immune response to the proteins in milk resulting in an allergic reaction.

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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 & 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 hypersensitivity, and comes from a lack of production of the enzyme lactase, required to digest the predominant sugar in milk. It should be noted that lactose intolerance is not actually a disease or malady, but merely the standard condition of 70% of the world's population. Adverse effects of lactose intolerance occur at much higher doses of milk 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 mucous 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 to be avoided by those with milk allergy include:

• milk
• yogurt
• butter
• cheese
• cream

Ingredients that also denote that food product contains dairy milk are:

• whey
• casein
• caseinate
• natural butter flavor.

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
• Products labeled "non-dairy", such as whipped topping and creamer
• margarine

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.

Those who are allergic to cow's milk should also avoid goat's milk and sheep's milk products.

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 Antihystamine 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. Milk allergy is more likely to be outgrown than peanut allergy.

Statistics

Milk allergy is the most common food allergy. It affects somewhere between 2% and 3% of infants in developed countries, but approximately 85-90% of children lose clinical reactivity to milk once they surpass 3 years of age.^[1]

Between 13% and 20% of children allergic to milk are also allergic to beef.^[2]

References

See also

• Food allergy
• Allergy
• Anaphylaxis