Milk allergy

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Not to be confused with Lactose intolerance.
Milk allergy
Glass of milk on tablecloth.jpg
A glass of pasteurized cow milk
Classification and external resources
ICD-9-CM 995.3, V15.02

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.

Classification[edit]

Milk allergy is a food allergy, an adverse immune reaction to a food protein that is normally harmless to the nonallergic individual.[1]

It is distinct from lactose intolerance, which is a nonallergic food sensitivity, and comes from a lack of production of the enzyme lactase, required to digest the predominant sugar in milk. Lactose intolerance is considered the normal state for most adults on a worldwide scale and is not typically considered to be a disease condition.[2]

Signs and symptoms[edit]

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.[1] Milk allergy can cause anaphylaxis, a severe, life-threatening allergic reaction, but this is rare.[1]

Mechanism[edit]

The major allergens in cow milk are αs1-, αs2-, β-, and κ-casein and the whey proteins α- and β-lactoglobulin.[1] The body may raise an antibody-based immuneresponse or a cell-based immune response to these allergens.[1]

Diagnosis[edit]

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 cell-based allergy, and the double-blind, placebo-controlled food challenge is important to rule out this form of allergy.[1]

Management[edit]

The main treatment for milk allergy is avoiding dairy products; because these proteins can be found in breast milk, nursing mothers should also abstain from dairy products prior to weaning.[1]

Because proteins in various mammalians are often cross-reactive, other forms of milk should not be substituted.[1]

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, known as amino acid formulas or elemental formulas, are considered the gold standard in the treatment of cows'-milk allergy when the mother is unable to breastfeed. Milk substitutes from soy, nuts and the like should not be considered as they are not nutritionally equivalent.[1]

The elimination diet should be tested every six months by testing milk-containing products low on the "milk ladder", like fully cooked foods containing milk, in which the milk proteins have been denatured, and ending with fresh cheese and milk.[1]

Accidental exposure[edit]

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.[3]

Outcomes[edit]

Generally, affected infants lose clinical reactivity to milk during early childhood or at latest by adolescence;[1] around half the cases resolve within the first year and 80-90% resolve within five years.[4]

Milk allergy is found to be associated with increased hospitalization rates and steroid use among children with asthma.[5][6]

Between 13% and 20% of children allergic to milk are also allergic to beef.[7]

Epidemiology[edit]

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.[1]

Research directions[edit]

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.[8] This is called oral immunotherapy. Sublingual immunotherapy may be somewhat safer, but less effective.[9] 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.[1][10]

No form of probiotic treatment had shown efficacy for treating milk allergy as of 2015.[1]

See also[edit]

References[edit]

  1. ^ a b c d e f g h i j k l m n 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
  2. ^ "Lactose intolerance". Genetics Home Reference. U.S. National Library of Medicine. Retrieved 2014-01-20. 
  3. ^ Tang AW. A practical guide to anaphylaxis. Am Fam Physician. 2003 Oct 1;68(7):1325-32. Review. Erratum in: Am Fam Physician. 2004 Mar 1;69(5):1049. PMID 14567487 [A practical guide to anaphylaxis. Free full text]
  4. ^ 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
  5. ^ 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. 
  6. ^ Simpson, Alyson B.; Glutting, Joe; Yousef, Ejaz (1 June 2007). "Food allergy and asthma morbidity in children". Pediatric Pulmonology 42 (6): 489–495. doi:10.1002/ppul.20605. PMID 17469157. 
  7. ^ 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. doi:10.1016/S1081-1206(10)62121-7. PMID 12487203. 
  8. ^ Nowak-Węgrzyn A, Sampson HA (March 2011). "Future therapies for food allergies". J. Allergy Clin. Immunol. 127 (3): 558–73; quiz 574–5. doi:10.1016/j.jaci.2010.12.1098. PMC 3066474. PMID 21277625. 
  9. ^ Narisety SD, Keet CA (October 2012). "Sublingual vs oral immunotherapy for food allergy: identifying the right approach". Drugs 72 (15): 1977–89. doi:10.2165/11640800-000000000-00000. PMC 3708591. PMID 23009174. 
  10. ^ 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.

External links[edit]