In earlier posts we have explained about food allergy and their management. Now today we will discuss cow milk allergy. We will highlight its symptoms and treatments so that you can understand.
Table of Contents
About cow milk
Cow milk is most easily available milk across the world and the cheapest available milk nearly in all areas of the world. Let us see its contents so that later on you can understand the cow milk allergy better and in detail.
To compare human breast milk with cow milk we will arrange the contents in table form:
| Item | ||
|---|---|---|
| Human Milk | Cow Milk | |
| Proteins | 1.1 gm/dl | 3.5 gm/dl |
| Casein:Whey | 40:60 | 80:20 |
| Lactose | 7 gm | 4.5 gm |
| Fat | 3.8 gm | 3.7 gm |
| Calcium:Phosphorus ratio | > 2 | < 2 |
| Calories | 67 cal | 70 cal |
| Osmolarity | 7.9 mOsm | 22.1 mOsm |
Cow milk contains more casein and human breast milk contains more amount of whey proteins and less amount of casein proteins.
At what age cow milk allergy is seen?
Cow milk allergy is first detected within the 1st year of life. It is usually detected when cow milk or cow milk based formula is started to infants.
All infants do not have cow milk allergy. Nearly 1-10 percent of all infants may have cow milk allergy.
Do They show allergy to other animal milk?
Yes, it is highly possible. Those with cow milk allergy are generally allergic to buffalo and goat’s milk. They may show similar symptoms when they consume milk from these animals.
Additionally children may be allergic to soy proteins.
What are the symptoms of the cow milk allergy?
The symptoms of cow milk allergy usually start within the 1st year of life and they occur when an infant is given cow milk or cow milk based formula.
Vomiting
Vomiting occurs within hours of taking feed. Usually it occurs within 1-3 hours of taking cow milk or cow milk based formula.
It may occur after each feed and infant may show signs of dehydration with so many vomiting episodes.
Diarrhea
Diarrhea occurs usually on the same day of the starting cow milk. It may be multiple watery loose motions in small or large amounts.
Diarrhea may be protracted and not responding to treatment. It results in dehydration and its complications if the offending agent is not removed from the feeding.
Blood in stool
Infant may suffer blood in the stool. The blood loss in stool may be visible or invisible to naked eye.
Continuing for a long period of time may cause chronic loss of blood in stool and resulting anaemia.
Failure to gain weight
Infant may fail to gain weight and even may show weight loss if the condition is allowed to continue.
Weight gain may restart when the offending agent is stopped and proper feeding is started.
Hypoproteinemia
Hypoproteinemia is a condition where an infant loses an amount of protein in stool and the blood level of albumin and protein decreases.
This causes reduced osmolarity of blood and the fluids from the blood vessels leak out from the blood vessel walls.
The symptoms of this condition are swelling of limbs and generalised body swelling. In extreme cases may cause ascites that accumulate water in the peritoneal cavity.
Distended abdomen
If the condition is allowed to be continued the abdomen of the infant may appear bloated or distended. This abdominal distention may be gaseous distension or because of accumulation of water i.e. ascites in the abdomen.
Irritability
Infants with this condition fed on cow milk or cow milk based formulae become irritable and there is refusal to feed and fussiness.
Shock
If still allowed to continue, the infant shows signs of excessive dehydration and there is shock and death in extreme cases.
How to diagnose cow milk allergy?
Cow milk allergy is easy to diagnose in infancy. The symptoms usually appear on starting cow milk or cow milk based formula.
The history is useful to establish the appearance of symptoms after the feeding. Usually the vomiting occurs within 1-3 hours of feeding and loose motions within 3-5 hours of feeding.
Prick test is not useful to diagnose cow milk allergy. It may come negative even in extreme forms of cow milk allergy. It may come positive in eosinophilic gastroenteropathy induced by cow milk.
Serum food specific IgE or serum IgE levels may not be indicative of the condition but this test may come negative. Serum food-specific IgE levels ≥15 kUA/L for milk is correct 95 percent of times if found positive.
Eosinophilia may be present or absent in this condition.
So the history of exposure and occurrence of the symptom is the most strong indicator of the cow milk allergy.
What is treatment of cow milk allergy?
Cow milk allergy causes severe symptoms. It may cause the protracted diarrhea that does not respond to other treatments. If this condition is allowed to continue and the offending agent is not removed from the food of the infant slowly it may lead to weight loss and failure to gain weight and even death in extreme cases.
The most effective treatment includes:
Stop cow milk
Cow milk, buffalo milk, sheep and goat milk are the offending agents. Cow milk and cow milk based formula should be stopped as early as possible for these infants.
Treat diarrhea
Diarrhea and vomiting in these infants causes dehydration. Treat the dehydration in these infants. Treating dehydration is the most important part of the treatment line.
Diarrhea may continue even after stopping cow milk for 7-10 days.
Protein hydrolysate formula
These infants cannot tolerate casein containing formula like cow milk of cow milk based formula. Give them hydrolysate formula. Hydrolysate formulas do not contain allergy causing agents and they may tolerate those formulas.
Treat anemia
Treat anemia if present at the time of the presentation. Patients may be severely anemic and may be in state of heart failure needing admission and treatment in ICU settings.
Severe anaemia may need blood transfusion done very cautiously under monitoring.
Treat hypoproteinemia
Hypoproteinemia may be another life threatening condition in these children. It needs treatment in ICU settings under cautious monitoring.
Monitor patient for few days
The gastro-intestinal symptoms may need 7-10 days time to resolve even with treatment. Till proper feeding is established and the patient is stabilized, the patient needs treatment in the ICU.
After that monitor the patient whether he/she is gaining weight with condition improving with new formula.
How to prevent food allergy?
Cow milk allergy is usually a food allergy and preventive measures for other food allergies are useful here too.
Following are the simple ways which help to reduce the incidences of the food allergies in children.
Exclusive breastfeeding
Breastfeeding is the best food for babies. We have already explained the benefits of breastfeeding in an earlier post. Exclusive breastfeeding for the first 6 months of the life protects infants and children from developing food allergies in future.
Complementary food
Complementary food should be started to infants at 6 months of age. Starting complementary food at 6 months of age after giving exclusive breastfeeding for the first 6 months of life reduces the chances of food allergy.
Introduce single food at a time
In complementary feeding infants should be introduced to single food at the time. Initially low risk food is introduced. Like if you are introducing rice, give the food made up of only rice for 4 days then introduce other pulses one by one.
High risk foods
Introduce potentially highly allergenic foods (fish, eggs, peanut products, milk, wheat) soon after the lower-risk foods (no need to avoid or delay)
Don’t avoid allergenic foods during pregnancy or nursing.
Soy-based formula
There is a myth that soy based formulas prevent allergic disease which is not true. Soy-based formulas do not prevent allergic disease.
References
- Milk & Dairy Allergy
- Cow’s Milk Protein Allergy
- Cow milk protein allergy and other common food allergies and intolerances
- Cow’s Milk Allergy: Immunomodulation by Dietary Intervention
- Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants
- Symptoms, Diagnosis, and Treatment of Cow’s Milk Allergy
- Epidemiology of Cow’s Milk Allergy
