Milk allergy congestion babies

Nutricia about signs and symptoms of cow’s milk allergy

The symptoms of cow’s milk allergy are wide-ranging and non-specific – meaning they are also found in many other conditions. Typically, symptoms affect the digestive and respiratory systems and the skin

^2-5. Many parents wait months for their baby to be diagnosed with cow’s milk allergy (also known as cow’s milk protein allergy)¹. The process can involve many doctor visits and can be distressing for both the parents and the child¹.

Cow’s milk allergy symptoms

Symptoms can happen right after feeding or be delayed by a few hours to several days^6,7. If your child often has any of the symptoms below, it is important that you discuss them with your doctor. It is also important to remember that many other conditions can result in these symptoms.

Digestive symptoms

Up to 60% of infants with cow’s milk allergy have gastrointestinal⁴ symptoms such as:

Many babies vomit, especially after feeding. However, if a baby is frequently vomiting after feeds, it may be time to see the doctor as it could point to gastroesophageal reflux disease (GERD) and/or cow’s milk allergy^5,7.

Reflux is common in infants younger than one year. In almost half of infants, reflux may be linked to cow’s milk allergy⁷. If your baby is having frequent reflux and/or is spitting-up a lot, discuss this with your doctor.

Diarrhea (multiple loose or liquid stools, several times a day) is a common digestive symptom in infants with cow’s milk allergy. While constipation is less common than diarrhea, it could also be a sign of cow’s milk allergy.

Blood resulting from irritation in the gut can also be a sign of cow’s milk allergy in infants.

Sticky mucus in their stools could resemble the mucus you see when you have a cold or runny nose. A little bit can be normal, but if you see a lot of mucus in your baby’s stool or it lasts a while, it is important that you let your doctor know about it.

Persistent gassiness

Gassiness is caused by too much air in the stomach or intestines and leads to discomfort. An excessively gassy baby may appear fussy, cranky or colicky. All babies have some degree of gas, but when it happens with several other symptoms, it may indicate an allergic reaction⁸.

Skin-related symptoms

Up to 70% of infants with cow’s milk allergy have symptoms that affect their skin⁴.

Cow’s milk allergy-related rashes often appear on the face but can appear anywhere on the body. They tend to be very itchy and uncomfortable and may be worse after feeding.

Respiratory symptoms

⁵

Up to 30% of babies with cow’s milk allergy have either mild or severe respiratory symptoms⁴.

Mild respiratory symptoms are similar to those of the common cold, including runny nose, sneezing and congestion. More severe symptoms can include shortness of breath or difficulty breathing and wheezing⁶. Seek immediate medical assistance for any serious respiratory issues.

General symptoms

Crying continuously and inconsolably for long periods – called ‘colic’ – is unusual. It can mean abdominal pain or be due to reflux, rash or other factors. Talk to your doctor if your baby cries for 3+ hours in a day, for 3+ days in a week, for over 3 weeks.

Sometimes slow weight gain may lead to a diagnosis of ‘Failure to Thrive’, which is one of the symptoms of cow’s milk allergy. 

What to expect when your doctor is investigating the possibility of cow’s milk allergy

Diagnosis will take into account your child’s medical history, symptoms and may include a variety of allergy tests.

Diagnosing cow’s milk allergy can take time, particularly if your child has a delayed allergic reaction to cow’s milk protein. But there are things you can do to help your doctor confirm or eliminate cow’s milk allergy as the cause of your child’s symptoms.

Symptom tracking

Your doctor is likely to ask a lot of questions around the details of your child’s symptoms. Keep a diary of when they feed and of any symptoms that occur after. Be sure to note down the time of feeding and when their symptoms happen, as well as for how long (minutes, hours, days). If you are breastfeeding, this diary should also keep record of everything you eat and drink. Aim to track your child’s food intake and symptoms for at least a week before seeing your doctor.

Diagnostic tests

Various tests are used to help diagnose food allergy. The most suitable allergy tests that your healthcare professional will undertake, will depend on the type of allergy your baby may have: IgE or non-IgE-mediated^5,6.

Immunoglobulin E (IgE) is an antibody, a protein produced by the immune system to fight against a pathogen – or what it thinks is a pathogen (in the case of cow’s milk allergy, it will try to fight against the protein in cow’s milk). When the body detects the cow’s milk protein, specific cow’s milk protein antibodies travel to cells that release the chemicals that cause the allergy symptoms.

Skin prick or blood tests are used for immediate allergic reactions (known as IgE mediated reactions). Elimination diets or food challenges may be used under the supervision of a qualified healthcare professional when your baby has delayed reactions (or non-IgE mediated reactions), because skin prick or blood tests are less effective for this type of allergy.

Blood test

A blood sample is screened for IgE antibodies, which are often higher in children with allergies.

Under the guidance of a doctor and/or dietician, foods that may be causing an allergy are removed from baby’s diet for 2-6 weeks at a time, and then slowly put back to confirm suspected diagnosis. Reintroducing a food that is confirmed to cause an allergy after a period of time is known as a ‘food challenge’. This should only be done under medical supervision.

Preparing to see a doctor: what questions might they ask if they are considering a diagnosis of cow’s milk allergy:

Think about your child’s medical history and their recent symptoms. When did they start? When do they tend to happen? How often? Are they always the same?
Is there a family history of allergies, including asthma and eczema?
It may help your doctor to bring your symptom diary to your appointment
Consider taking photos of your baby’s rashes/soiled nappies to show your doctor
Plan and draft a list of questions to ask your doctor

References

Sladkevicius E, Nagy E, Lack G, et al. J Med Econ 2010; 13(1): 119-128.
Høst A. & Halken S. Allergy 1990; 45: 587-596.
Meyer R et al. Current Allergy & Clinical Immunology 2012: Vol 25.
Høst A. Ann Allergy Asthma Immunol 2002;89:33-37.
Koletzko S, Niggemann B, Arato A, et al. J Pediatr Gastroenterol Nutr 2012; 55(2):221-229.
Fiocchi A, Brozek J, Schunemann H, et al. Pediatr Allergy Immunol 2010;21:1-125.
Salvatore S, Vandenplas Y. Pediatrics. 2002 Nov;110(5):972-84. doi: 10.1542/peds.110.5.972. PMID: 12415039.
Venter C, Brown T, Meyer R, et al. Clin Transl Allergy. 2017 Aug 23;7:26. doi: 10.1186/s13601-017-0162-y. Erratum in: Clin Transl Allergy. 2018 Jan 25;8:4. PMID: 28852472; PMCID: PMC5567723.

Milk Allergy in Infants (for Parents)

What Is a Milk Allergy?

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow's milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like

histamine.

Cow's milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.

People of any age can have a milk allergy, but it's more common in young children. Many kids outgrow it, but some don't.

If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

What Are the Signs & Symptoms of a Milk Allergy?

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

wheezing
trouble breathing
coughing
hoarseness
throat tightness
stomach upset
vomiting
diarrhea
itchy, watery, or swollen eyes
hives
swelling
a drop in blood pressure causing lightheadedness or loss of consciousness

The severity of allergic reactions to milk can vary. The same child can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.

Children also can have:

an intolerance to milk in which symptoms — such as loose stools, blood in the stool, refusal to eat, or irritability or colic — appear hours to days later
lactose intolerance, which is when the body has trouble digesting milk

If you're not sure if your child has an intolerance versus an allergy, talk to your doctor.

If Your Child Has an Allergic Reaction

If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.

If your child has symptoms of a serious reaction (like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting):

Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

How Is a Milk Allergy Diagnosed?

If you think your infant is allergic to milk, call your baby's doctor. He or she will ask you questions and talk to you about what's going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist (a doctor who specializes in treating allergies).

The allergist might do skin testing. In skin testing, the doctor or nurse will place a tiny bit of milk protein on the skin, then make a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area like an insect bite.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Avoiding a Milk Allergy Reaction

If You're Breastfeeding

If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.

If You're Formula Feeding

If you're formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

You also might see "partially hydrolyzed" formulas, but these aren't truly hypoallergenic and can lead to a significant allergic reaction.

If you're concerned about a milk allergy, it's always best to talk with your child's doctor and work together to choose a formula that's safe for your baby.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy are not safe for infants.

If you have any questions or concerns, talk with your child's doctor.

Allergy to cow's milk protein in children

: 03/22/2020

Food allergy is a food-induced adverse (pathological) reaction based on immune mechanisms. In children under one year of age, the most common cause of food allergy is cow's milk protein (CMP).

A distinction is made between cow's milk protein allergy and cow's milk protein intolerance. In the first case immune mechanisms are involved, in the second - the baby simply does not have enough enzymes to digest cow's milk protein (for example, lactase deficiency).

There are only 36 cow's milk protein allergens, but 4 of them most often cause food allergies.

Casein is 80% BCM, it is heat stable (does not break down when boiled) and is not a species-specific protein. This means that if you are allergic to it, you may be allergic to the milk of other animal species.

β - lactoglobulin has the highest allergenic activity, species-specific, does not break down when boiled. This protein is not found in human milk.

α - lactalbumin is destroyed by boiling, species-specific.

Bovine serum albumin is not destroyed by boiling If an allergy to this cow's milk protein is detected, the child may also react to beef and veal meat.

It should be noted that mainly children who are bottle-fed with mixtures based on cow's milk protein suffer from cow's milk protein allergy.

This type of allergy can also develop in children who are breastfed - if the diet of a nursing mother contains products containing cow's milk protein (milk, cheese, cottage cheese, sour cream, butter, fermented milk products), especially in large quantities.

What symptoms suggest that the baby may be allergic to CMP:

Skin manifestations (dry skin, dry nummular rashes, skin itching).
Gastrointestinal manifestations (bloating, regurgitation, vomiting, loose stools, possibly stools with mucus and blood streaks).
Respiratory manifestations (itchy eyes, cough, nasal congestion and even urticaria and Quincke's edema). These symptoms are rare in toddlers, but still possible.

Diagnosis

I must say that if the first manifestations of a food allergy in a baby appeared after switching to artificial feeding with a "regular" adapted formula based on cow's milk, then this is a reason to suspect cow's milk proteins as an allergen.

The next thing is correct history taking : the doctor will definitely find out if anyone in your family suffers from allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis, hay fever). If the family has these diseases, the risk of developing allergies in the baby increases.

At the discretion of the doctor, it is possible to take blood from a child for the presence of immunoglobulin E (IgE) antibodies to cow's milk proteins, which were mentioned above. In the presence of IgE antibodies to CMP in the baby's blood, almost 100% confirms that he has an allergy. Paradoxically, the absence of these antibodies does not rule out an allergy to cow's milk proteins, but only indicates that the allergy proceeds through a different type of allergic reaction.

And the simplest, most important and affordable method is the diagnostic diet with the exclusion of products from the child's diet (or from the mother's diet during breastfeeding) containing CMP. The duration of this diet is from 1-2 to 4 weeks. If during these periods there is no improvement in the condition of the baby, then an allergy to CMP is unlikely.

If the child's condition improves, you may need challenge test . This means the introduction of dairy products into the child's diet again. And if the manifestations of allergies return, this will prove an allergy to BCM. This test is carried out under strict medical supervision.

In children who are fed exclusively with breast milk, it is necessary to exclude products containing CMP from the mother's diet .

There are 3 types of mixtures:

based on the hydrolysis of whey proteins;
based on the hydrolysis of the casein fraction;
based on amino acids.

Allergy is possible for the first two options, the reaction is very unlikely for the third option.

If the baby is bottle-fed, then it must be transferred to amino acid blend or highly hydrolyzed blend. Most infant formulas are made with whole proteins and are therefore not suitable for babies allergic to CMP. They also do not recommend hypoallergenic mixtures, since the protein in them is not sufficiently split and mixtures in goat's milk (cross-reactions).

Usually, allergists first transfer children to mixtures based on complete hydrolysis of BCM or casein, if there is no proper effect within 2-3 weeks, it is recommended to transfer the baby to an amino acid mixture.

Perhaps, if the child has severe manifestations of food allergies, the doctor will advise you to immediately transfer the baby to an amino acid mixture. By agreement with the doctor, it is possible to transfer the child to a mixture based on soy protein isolate (from 6 months).

Amino acid mixtures are more easily tolerated by children with various forms of food allergies, as they do not have the bitter taste characteristic of mixtures with a high degree of protein hydrolysis.

Amino acid mixtures can be used both for the short term diagnosis of CMP allergy and as a dietary base for long term use in children with food allergies.

Diet duration — at least 6 months . Then the issue of transferring the baby to a hypoallergenic mixture is decided. In case of recurrence of symptoms, the introduction of dairy products is postponed for another 6 months.

The prognosis for CMP allergy in infants and young children with the correct management of patients is favorable.

Approximately 50% of children by the age of 1 year can be introduced into the diet of foods that include CMP. More than 75% of children by age 3 or older 90% of children by the age of 6 do not show allergic reactions to CMP.

Good to know about MILK ALLERGY (melk)

MILK ALLERGY

Useful information about milk allergy – Information sheet of the Norwegian Asthma and Allergy Association

What is milk allergy?

When allergic to cow's milk protein, a strong reaction of the body's immune system may be the production of antibodies (IgE), or the activation of inflammatory cells. With every meal containing milk proteins, an allergic reaction of the immune system is observed in the form of the production of mediators, such as histamine, or a T-cell inflammatory reaction. Histamine is produced in several places in the body and leads to symptoms such as diarrhea, nausea, abdominal pain, or skin lesions (urticaria, eczema).

Cow's milk contains over 25 different proteins that can cause a reaction in "milk" allergy sufferers. For most people, an allergic reaction can be caused by more than one type of protein. The milk of other artiodactyls such as goat, horse and buffalo contains many of the same proteins. Therefore, allergy sufferers should not consume artiodactyl milk at all.

If a breastfeeding mother herself consumes cow's milk, some proteins may be transferred with mother's milk to the baby's body and lead to negative consequences. Therefore, a breastfeeding mother should follow a dairy-free diet.

Cow's milk allergy is not the same as lactose intolerance. The latter occurs due to the reduced ability of the body to digest milk sugar (lactose). Lactose intolerance leads to stomach pain and diarrhea as a consequence of eating large amounts of dairy products with high levels of lactose (sweet milk, brown (goat) cheese, ice cream and cream).

Symptoms

The symptoms of a milk allergy are very individual. For some, they are minor and harmless, while for others, a severe allergic reaction can occur, even when drinking a small amount of milk. Gastrointestinal tract disorder is common. Not so often there is itching in the mouth and throat, swelling of the mucous membrane and breathing problems, which is especially true for young children. It is also common for them to develop eczema and hives on the skin.

Who is affected?

Milk allergy is the most common type of allergy in young children, which is explained by the early introduction of cow's milk into the diet of infants (eg cereals or mother's milk substitute). About 2-5% of Norwegian babies (0-3 years old) suffer from this type of allergy.

Diagnosis

In order to determine the presence of a milk allergy, the doctor must read the patient's medical history, as well as take a blood test for the presence of allergic antibodies and a Pirquet test. Not all milk allergy sufferers will show positive results from these tests. This is especially true for infants with symptoms such as vomiting, diarrhea, or blood in the stool. The only reliable way to find out if milk causes these symptoms is to eliminate milk from the diet for a period of time. When in doubt, reintroduce it back into the diet and see if symptoms return. For children who have not received milk for some time due to allergies, a control test using cow's milk should be performed to ensure that there is no allergic reaction.

Predictions

Generally, cow's milk allergy has a fairly good prognosis. Most of the children get rid of it before reaching school age. Babies who have had negative test results are often allowed to resume milk intake after half a year or a year. It is not known how many adults suffer from milk allergy, but it is estimated that this number does not exceed one percent of the population.

Where is milk protein found?

Milk is found in many processed and prepared industrial foods. Therefore, when buying a product, it is important to familiarize yourself with the list of substances contained in it. The goods declaration must list all ingredients containing milk. A certain group of words used in such lists indicates the content of milk protein in the product: butter, yogurt, yogurt powder.

Cocoa butter, lactic acids and group E substances do not contain milk protein.

Diet

Milk is an important source of nutrients in the Norwegian diet. 25% of the protein given to children, 70% of the iodine and about 70% of the calcium are obtained from dairy products. That is why, in cases of exclusion of dairy products from the diet, these products should be replaced with others that will provide the intake of the above nutrients.