|A glass of pasteurized cow milk|
A milk allergy is a food allergy, an adverse immune reaction to one or more of the constituents of milk from any animal (most commonly alpha S1-casein, a protein in cow's milk). This milk-induced allergic reaction can involve anaphylaxis, a potentially life-threatening condition.
Signs and symptoms
The effects of antibody-mediated allergy are rapid in onset, evolving within minutes or seconds. These allergies always arise within an hour of drinking milk; but can occasionally be delayed longer when eating food containing milk as an ingredient. The effects of non-antibody-mediated allergy is delayed; because it is not caused by antibodies, it can take several hours, or even up to 72 hours to produce a clinical effect. The most common symptoms for both types are hives and swelling, vomiting, and wheezing, with symptoms first arising in skin, then the GI tract, and less commonly, the respiratory tract. Milk allergy can cause anaphylaxis in about 1–2% of cases, which is a severe, life-threatening allergic reaction.
The major allergens in cow milk are αs1-, αs2-, β-, and κ-casein and the whey proteins α- and β-lactoglobulin. The body may raise an antibody-based immuneresponse or a cell-based immune response to these allergens. The reaction to cow milk is caused by IgE and non-IgE mediated responses, with the latter being the most frequent. The non-IgE reactions involving the gastrointestinal tract are typically delayed while IgE reactions such as hives are much more immediate.
Diagnosis is carried out by first doing a diagnostic elimination diet, skin prick tests, measuring IgE in blood, and conducting in-office food challenges. A double-blind, placebo-controlled food challenge is still the gold standard for the diagnosis for all food allergies, including milk allergies. A negative IgE test doesn't rule out antibody-based allergy (in the case of false negatives), or cell-mediated allergy. Therefore, double-blind, placebo-controlled food challenge is important to rule out this form of allergy.
Because proteins in various mammalians are often cross-reactive, other forms of milk should not be substituted.
Milk substitute formulas are used to provide a complete source of nutrition for infants. Milk substitutes include soy-based formulas, hypoallergenic formulas based on partially or extensively hydrolyzed protein, and free amino acid-based formulas. Nondairy-derived, amino acid-based formulas (elemental formulas) such as Neocate, EleCare, and Puramino, are considered the gold standard in the treatment of cows'-milk allergy when the mother is unable to breastfeed.[medical citation needed] Milk substitutes from soy, nuts, and the like should not be considered as they are not nutritionally equivalent.
The elimination diet should be tested every six months by testing milk-containing products low on the "milk ladder", such as fully cooked foods containing milk, in which the milk proteins have been denatured, and ending with fresh cheese and milk.
Treatment for accidental ingestion of milk products by allergic individuals varies depending on the sensitivity of the person. Frequently medications such as an epinephrine pen or an antihistamine such as diphenhydramine (Benadryl) are prescribed by an allergist in case of accidental ingestion. Sometimes prednisone will be prescribed to prevent a possible late phase Type I hypersensitivity reaction.
Generally, affected infants lose clinical reactivity to milk during early childhood or at latest by adolescence; around half the cases resolve within the first year and 80-90% resolve within five years.
Between 13% and 20% of children allergic to milk are also allergic to beef.
Milk allergy is the most common food allergy in early childhood. It affects between 2% and 3% of infants in developed countries; the incidence in only-breastfed infants is lower, at about 0.5%. These figures appear to be antibody-based allergy; allergy based on cellular immunity is uncertain.
Desensitization, which is a slow process of eating tiny amounts of milk, until the body is able to tolerate more significant exposure, results in reduced symptoms or even remission of the allergy in some people and is being explored for milk allergy. This is called oral immunotherapy. Sublingual immunotherapy may be somewhat safer, but less effective. A 2014 meta-analysis found desensitization to be relatively safe and effective but found that further study was needed to understand the overall immune response to it, and questions remain open about duration of the densensitization.
- Lifschitz C, Szajewska H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015 Feb;174(2):141-50. PMID 25257836 PMC 4298661
- Deng Y, Misselwitz B, Dai N, Fox M (2015). "Lactose Intolerance in Adults: Biological Mechanism and Dietary Management". Nutrients (Review). 7 (9): 8020–35. PMC . PMID 26393648. doi:10.3390/nu7095380.
- Tang AW (2003). "A practical guide to anaphylaxis". Am Fam Physician. 68 (7): 1325–1332. PMID 14567487.
- Caffarelli C, et al. Cow's milk protein allergy in children: a practical guide. Ital J Pediatr. 2010 Jan 15;36:5. Review. PMID 20205781 PMC 2823764
- Sympson, A.B.; Yousef, E. (31 December 2006). "Association Between Milk Allergy, Steroid Use, And Rate Of Hospitalizations In Children With Asthma". Journal of Allergy and Clinical Immunology. 119 (1): S116. doi:10.1016/j.jaci.2006.11.436.
- Simpson, Alyson B.; Glutting, Joe; Yousef, Ejaz (1 June 2007). "Food allergy and asthma morbidity in children". Pediatric Pulmonology. 42 (6): 489–495. PMID 17469157. doi:10.1002/ppul.20605.
- Martelli A, De Chiara A, Corvo M, Restani P, Fiocchi A (December 2002). "Beef allergy in children with cow's milk allergy; cow's milk allergy in children with beef allergy". Ann. Allergy Asthma Immunol. 89 (6 Suppl 1): 38–43. PMID 12487203. doi:10.1016/S1081-1206(10)62121-7.
- Nowak-Węgrzyn A, Sampson HA (March 2011). "Future therapies for food allergies". J. Allergy Clin. Immunol. 127 (3): 558–73; quiz 574–5. PMC . PMID 21277625. doi:10.1016/j.jaci.2010.12.1098.
- Narisety SD, Keet CA (October 2012). "Sublingual vs oral immunotherapy for food allergy: identifying the right approach". Drugs. 72 (15): 1977–89. PMC . PMID 23009174. doi:10.2165/11640800-000000000-00000.
- Martorell Calatayud C, et al. Safety and efficacy profile and immunological changes associated with oral immunotherapy for IgE-mediated cow's milk allergy in children: systematic review and meta-analysis. J Investig Allergol Clin Immunol. 2014;24(5):298-307. PMID 25345300 Free full text.