Cow’s Milk Protein Allergy
Cow’s Milk Protein Allergy Causes
This pathology is based on allergy to protein components of cow’s milk: alpha-lactalbumin, beta-lactoglobulin and casein. Genetic studies have shown that if both parents suffer from atopic diseases, the probability for the child to be allergic to cow’s milk protein is 23%. The risk in the general population is 2% -3%.
The exact cause of disease is not fully known. The cause of the symptoms is a immune reaction type IV, cellular, with the intervention of multiple cytokines, which will increase the intestinal permeability and will lead to a increased absorption of foreign proteins, which will enhance the pathogenic chain.
Cow’s Milk Protein Allergy Symptoms
The clinical picture is dominated by enteral-like symptoms:
- Abdominal bloating.
- Neutral weight or weight loss.
- Bloody stools may occur, which can guide to a diagnosis of colon damage.
- In cases of neglected forms of disease, atrophic intestinal lesions can occur.
Cow’s Milk Protein Allergy Diagnosis
Diagnosis of cow’s milk protein allergy is based on the cow’s milk elimination test, that causes the symptoms. The clinical diagnosis can not be replaced with any other paraclinical investigation or serologic analysis. In enteral form cow’s milk protein allergy, specific Ig E are not highlighted, early in the disease and the presence of specific IgG, does not confirm the disease.
Provocation test is also available for diagnosis, but it is considered a risky procedure in a infant with enteral obvious symptoms. The test is recommended to be postponed until the age of 6 months. This test should be performed by a doctor because of the risk of anaphylactic shock.
The test begins with a skin test and if local skin reactions appear, then no further testing is needed. If no skin reaction are present, 5 ml of cow’s milk will be administrated, quantity that can be increased later, if there are no symptoms. It should be noted that gastrointestinal symptoms may occur after a week of testing, therefore the test results, positive or negative are best appreciated after a week interval.
Intestinal mucosa changes in cow’s milk protein allergy are present in the moment of diagnosis. If the baby in question, also received foods containing gluten, besides cow’s milk, differential diagnosis with celiac disease is difficult to achieve.
Cow’s Milk Protein Allergy Treatment
Treatment is based on the exclusion diet. If possible, the diet of the infant should be to be switched to breast milk. If this is not an option, extensively hydrolysed milk formulas will be administrated. Milk formulas which are containing soy protein may be used in forms of cow’s milk protein allergy with extra-digestive manifestations, because forms of disease with digestive manifestations are frequently associated with allergy to soy preparations.
Cow’s Milk Protein Allergy Prevention And Prognosis
Prevention is based on natural diet until the age of six months, especially in families where allergic diseases are present. After the age of 6 months, administration of cow’s milk, will cause very rarely serious allergic symptoms. The prognosis is good and symptoms of allergy will disappear in most cases, around the age of 2 years.