Cow's Milk Allergy, Cow’s Milk Allergy

Cow’s Milk Allergy

Cow’s milk allergy is most common in 0-3 age. Cow’s milk allergy shows symptoms such as eczema, hives, bloody stool, mucous stool, vomiting, constipation. Early diagnosis is important in child with symptoms of cow’s milk allergy. After diagnosis of cow’s milk allergy, it is very important to diet against foods containing milk and to be careful about cow’s milk allergy in every area.

What is Cow’s Milk Allergy?

Reactions occuring with immunological mechanisms to proteins in cow’s milk are called cow’s milk protein allergy (CMPA). Cow’s milk contains at least 20 protein components that can cause antibody production in humans.

What is the Frequency of Cow’s Milk Allergy?

Cow’s milk allergy is one of the main cause of food allergy in infants and children younger than 3 years old. The incidence varies by region, but it is 2-6% in infants. It drops to 1% in older children.

What are the Causes of Cow’s Milk Allergy?

Most important cause of cow’s milk allergy is genetics. In addition to genetics, many risk factors can affect the development of food allergies.

Is Genetics (heredity) Important?

Cow’s milk allergy is more common in children whose relatives have allergic diseases especially in mothers, fathers, siblings or close relatives. This is because allergic diseases are genetically transitive. But since many genes are responsible, it is in the form of predisposition.

What are the Risk Factors of Cow’s Milk Allergy?

  • Allergy in the family: If there is eczema, urticaria (hives), allergic asthma, or other allergic diseases in the family, mothers, fathers or siblings, the child has an increased risk of cow’s milk allergy.
  • Other allergic diseases: Allergic eczema is the most common allergic disease that is seen together with cow’s milk allergy. If your child has allergic eczema, food allergy, especially cow’s milk should be investigated. The presence of other allergic diseases also increases the risk of cow’s milk allergy, and vice versa.
  • Age: Food allergy is most common in children 0-3 years old. Cow’s milk also causes allergies most frequently at this age. As children grow older, tolerance develops and cow’s milk allergy disappears. Therefore, more care should be taken in terms of cow’s milk allergy in the first 3 years of age.

What are the Symptoms of Cow’s Milk Allergy?

In the intake of any food containing cow’s milk, findings occur in different systems, most often skin. It can be itching, redness, urticaria (hives), eczema, on the skin. Digestive system findings such as vomiting, diarrhea, mucous stool, bloody stool, gas pain, constipation; nose symptoms such as sneezing, itching, runny nose; lung symptoms such as wheezing, cough, and shortness of breath may occur. In severe cases, a life threatening allergic shock called anaphylaxis may occur.

When you give your child some food that contains cow’s milk, if one or more of the symptoms occur, cow’s milk allergy must be suspected and you should contact a pediatric allergist;

  • Symptoms of eczema (Redness in the cheeks, neck, joints, dry skin)
  • Itching and rashes on your body
  • Redness around the lip, swelling on tongue or lip within 1-2 hours after feeding
  • Blood and / or mucus (snot) in stool
  • Recurrent and undetectable reason of vomiting
  • Reflux that does not respond to treatment
  • Constipation with no cause
  • Severe gas pain (lasts more than 3 weeks and more than 3 hours of restlessness)
  • Recurrent wheezing in the lung, shortness of breath, nasal congestion and / or runny nose
  • Common itchy rash, breath tightness and palpitations in the body called allergic shock after cow’s milk intake

If one or more of these symptoms are present, cow’s milk allergy should be investigated.

Which doctor should I go to if my child is allergic to cow’s milk?

When symptoms of cow milk allergy appear, it would be beneficial to take your child to the pediatric allergist. Because;

Pediatric allergy specialists are the most educated and experienced specialists in this regard.

  • If you are wrongly diagnosed with cow’s milk allergy, unnecessary diets that may cause many problems, or if a child with a cow’s milk allergy is not dieted, serious health conditions may arise. Therefore, accurate diagnosis is of great importance.
  • Food allergy may be the beginning of an allergic march. A child with a food allergy who has not been diagnosed and treated yet has increased the risk of developing asthma and allergic disease as the child grows. Therefore, attention should be paid to the symptoms of asthma and allergic diseases and it should be monitored by an experienced specialist.

How Should I Prepare, When I Go to Doctor for Cow’s Milk Allergy?

It will be useful to pay attention to the following points when coming to the examination in order to provide the diagnosis in a short time.

  • Note all the symptoms. Photograph visible findings if possible.
  • Note and bring with you all the drugs your child use.
  • Bring with you any pre-made tests.
  • Note all the questions you would like to ask to doctor.
  • To be able to do skin test when it is required to detect cow’s milk allergy, if allergy and cough medications are used, stop them 1 week in advance (These drugs affect the test result).

How to Diagnose Cow’s Milk Allergy?

For the diagnosis of cow milk allergy, firstly symptoms should be evaluated.

For the diagnosis of cow milk allergy, first of all, there should be signs of cow’s milk allergy. A detailed assessment should then be made. Cow’s milk allergy usually manifests itself before the age of 2. It is less likely to develop cow’s milk allergy after 2 years of age.

Allergy Test That Should Be Done For Cow’s Milk Allergy

In children with symptoms of cow milk allergy, the diagnosis is made by child allergy specialists, with tests such as skin allergy testing, blood allergy testing, interruption of cow milk intake, and cow milk provocation tests.

It is more valuable to have a food allergy test on the skin. Both faster and more reliable results are obtained. Tests on the skin give results within 15-20 minutes. For this reason, it is generally preferred to conduct an allergy test on the skin in the diagnosis of cow milk allergy. However, in some cases both two must be used. Because diagnosis may not be made by tests alone. In case of doubt, the diagnosis is made with cow’s milk provocation test. This test should be done at the centers with pediatric allergist who is experienced in this field. Performing by inexperienced people can have dangerous consequences as severe allergy symptoms may develop during the test.

How old a child should be to get an allergy test for cow’s milk allergy?

Allergy test from the skin can be done after 1 month old. Testing should be done when cow milk allergy is suspected because it starts during infancy. Information of skin allergy testing can be done after the age of five is absolutely not true.

What other blood tests are used for cow’s milk allergy?

In recent years, a method called component-based diagnostic (Component resolved diagnosis-CRD) method, which measures all allergic proteins separately in cow’s milk, has been developed. In this way, a more accurate diagnosis and treatment is provided by determining which allergen the child is sensitive to in milk. For these tests, a blood sample is taken from your child and examined in the lab to measure antibodies.

In addition, the determination of IgG antibodies against cow milk protein, which is viewed from the blood on the agenda in recent years, has no role in diagnosis.

Endoscopy and biopsy

In the presence of meaningless and persistent digestive system complaints, growth deficiency or iron deficiency anemia that cannot be explained otherwise, it is a correct approach to take upper and lower digestive system endoscopic biopsies. There are no definitive findings showing cow milk allergy. But it allows to diagnose diseases other than cow’s milk allergy.

Keep a Food Diary

Foods that the mother and the child receive if breastfeeding should be recorded in the diary of the food every day and the hours with allergy symptoms should be noted.

However, the family’s observation is not sufficient for the diagnosis of cow milk allergy. According to the findings, a blood or skin test should be done, and if they are insufficient, a food provocation test should be performed. Children who are normal in blood and skin allergy tests may also have cow milk allergy, which we call non-IgE allergies (especially in isolated bowel involvement), which does not appear in allergy tests. Diagnosis of this condition is made by diet and provocation tests.

It is inconvenient to diet only according to the information given by the family or according to the result of an allergy test made from blood or skin. It can cause serious consequences.

How is cow milk allergy treated?

When a cow milk allergy is diagnosed, the first thing to do in treatment is to avoid all foods that contain cow milk. If the baby is only breastfeeding, the mother should not receive foods containing cow’s milk. If the baby is not breastfeeding, he should use fully hydrolyzed or amino acid-based formulas used in cow milk allergy. Some children can tolerate baked goods (heated up to 200-220° C). This situation should be evaluated by your allergy doctor together with the tests.

If the tolerance has not developed despite the necessary age, oral immunotherapy (vaccine treatment by giving milk by mouth) can be performed against cow’s milk.

Your child can also consume cow milk, or foods that contain cow milk, without noticing. In such cases, symptoms ranging from mild to severe occur. Treatments vary according to these symptoms.

Treatment for Mild Reactions

In mild reactions of cow milk allergy, antihistamine drugs recommended by your allergist help reduce symptoms. These antihistamine drugs are used to relieve the child by reducing symptoms such as itching, urticaria, flushing, and swelling in the body, which appears after your child receives the food that contains cow milk that he is allergic to.

Treatment for Serious Reactions

You should apply to an emergency room for severe symptoms seen in your child. With the treatments applied here, anaphylaxis shock, which may be life-threatening, is prevented.

If there are severe symptoms with cow milk intake, then an adrenaline autoinjector should be kept in order to avoid dangerous conditions and should be applied immediately when symptoms occur and contact the nearest emergency room immediately.

What happens if cow’s milk allergy is not treated?

Conditions That Can Develop When Cow’s Milk Allergies Are Not Treated

If your child is allergic to cow milk, and if not treated this may cause other health problems. These health problems can affect your child’s life or can be life-threatening in very serious problems. Therefore, the treatment of cow milk allergy should be considered important and should not be ignored.

We can list the health problems that may occur when cow milk allergy is not treated as follows;

  • Anaphylaxis: If your child’s cow milk allergy is not diagnosed as soon as possible after symptoms begin, a shock condition called anaphylaxis may occur when he eats foods that contain cow’s milk, which he is allergic to. Anaphylaxis is a life-threatening reaction that poses a serious risk.
  • Atopic dermatitis (Eczema): When your child’s cow milk allergy is not treated, it can cause atopic dermatitis / eczema. Because allergens that cause atopic dermatitis are mostly food allergens.

Will cow’s milk allergy improve?

Cow milk allergy improves with growing up. Tolerance develops in 50% of patients at 1 years old, in 75% of them at 3 years old, and in 90% of them at 6 years old. But if the family has an allergic disease, cow milk sIgE is very high and also if allergic to casein protein, cow milk allergy in such children usually tends to prolong.

As a result;

  • Cow milk allergy can appear with a wide range of symptoms.
  • Allergy testing can be done at any age to diagnose cow milk allergy.
  • Diagnosis of cow milk allergy may not be made with blood and / or skin allergy tests alone.
  • It is very important that all methods are evaluated and diagnosed by an experienced pediatric allergy specialist.
  • The most important point in treatment is to avoid cow milk until tolerance develops.
  • In cases of severe reaction, an adrenaline auto injector should be available and, if necessary, should be made immediately as a life-saving until reaching to the hospital.
  • In most of the patients, tolerance develops when they reach a certain age.

In cases where tolerance is delayed, immunotherapy (vaccine therapy) can be tried by experienced pediatric allergists. You should consider this with your doctor.

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