Milk Allergy Treatment for Children

Diagnosis and Testing Options for Milk Allergy

Cow’s milk allergy is the most common food allergy in young children and affects approximately 2% of the children under 2 years of age. Cow’s milk is the third most common food, after peanut and tree nuts, responsible for food induced anaphylaxis in paediatric population. Only a small number of infants (0.5%) react to the cow’s milk protein found in maternal breastmilk.

Milk allergy presents with a wide range of clinical symptoms that can be immunoglobulin IgE mediated or non-IgE mediated. Lactose intolerance is a nonimmune mediated reaction and is not classed as milk allergy.

Cow’s milk protein is made up of proteins; casein, whey proteins, bovine lactoferrin and bovine serum albumin. Cooking diminishes the allergenicity of the whey proteins due denaturation of heat sensitive proteins. This may explain why extensively heated milk is better tolerated. Similarly yoghurt, which ferment and acidify milk, diminishes the amount of intact whey protein in the milk and may result in tolerance of yoghurt based dairy products.

IgE mediated reactions usually occur immediately, within minutes up to 2 hours after ingestion. Reactions can vary from mild to life-threatening anaphylaxis.

Mixed IgE and non -IgE mediated reactions

These may present as acute and/or chronic symptoms. Milk is the second most common allergy (hen’s egg is the most common) reported in infants and young children with moderate to severe atopic dermatitis (Eczema). Allergic eosinophilic gastrointestinal disorders present with symptoms of gastroesophageal reflux but are unresponsive to conventional treatments.

Non-IgE mediated reactions have a delayed onset of action. The presentation could be varied as; Food protein induced proctocolitis, food protein induced enterocolitis syndrome (FPIES), food protein induced enteropathy, gastroesophageal reflux disease, infantile colic, constipation or eczema exacerbation.

Diagnosis: Clinical history supported by the following tests. Assessments should be undertaken every 6-12 months.
IgE mediated allergy
Skin Prick Test
Blood test- Total IgE and IgE to milk
Component milk protein test – Casein, alpha-lactalbumin, beta-lactalbumin, BSA

Non IgE mediated allergy
Milk exclusion for 2 weeks, followed by 2 weeks of milk inclusion to confirm Management: Tolerance is achieved by majority of children. Non IgE mediated cow’s milk allergy tends to resolve by early childhood, IgE mediated cow’s milk allergy may persist into adolescent and beyond.

Cow’s milk exclusion – to give, plant-based milk/ Extensively hydrolysate milk /
Amino acid formula milk

Treatment:
iMAP Milk ladder
Cow’s milk immunotherapy