Often the term “intolerance” is used inappropriately instead of “allergy”, two very different conditions that also involve different age groups. It happens for example in the delicate field of intolerance to milk proteins. And just to clarify we asked Dr. Pasquale Comberiati, allergist pediatrician of the University of Pisa, to explain how and when it occurs and how to protect yourself. Here’s what he replied.
At what age does milk allergy occur?
“Cow’s milk protein allergy typically occurs in the first year of life. Symptoms usually appear when breast milk is supplemented or replaced with infant formula (made from cow’s milk), or when first intakes of cow’s milk derivatives (e.g. cheese, yogurt) in children exclusively breastfed up to that point. . Rarely, the symptoms of milk allergy can also appear in babies who are exclusively breastfeeding and in this case they are due to the passage into the mother’s milk of the cow’s milk proteins that the mother takes with the diet. ”
What is the difference between milk protein allergy and lactose intolerance?
«L’ milk allergy (or cow’s milk protein allergy) is a condition due to an abnormal reaction of the immune system against the proteins contained in cow’s milk. It mainly affects children in the first years of life, while it is rare in adults. Symptoms can involve the skin, gastrointestinal, respiratory and cardiovascular systems. The severity of symptoms can vary, and severe reactions can be life-threatening. L’Lactose intolerance, is a condition in which the body cannot digest lactose, a sugar contained in cow’s milk and other mammals, due to the more or less marked deficiency of an intestinal enzyme called lactase. It mostly affects adolescents and adults. Symptoms are mainly gastrointestinal (nausea, bloating, abdominal pain, flatulence, diarrhea and sometimes constipation). L’intolerance to cow’s milk proteins it’s a terminology used improperly, often also by doctors, as a synonym for Allergy to cow’s milk proteins. This terminology should no longer be used because it creates confusion ”.
What are the symptoms of cow’s milk protein allergy
«They stand out two forms of milk allergy, one with immediate symptoms and one with delayed symptoms. In the’allergy with immediate symptoms, these appear within a few minutes or at most 2 hours after taking milk or dairy products. In children, i symptoms usually involve the skin with redness of the skin (erythema), raised, reddish, hot and itchy skin patches of varying size, localized to the face or spread to the body (urticaria), and swelling (angioedema) of the face and extremities (lips, tongue, eyelids, hands and feet). AND the gastrointestinal system with itching in the mouth, abdominal pain, vomiting and diarrhea. In severe cases, symptoms may also involve the respiratory system with rhinitis, throat tightness, hoarseness (sudden change in tone of voice or cry), stridor (sharp noise when inhaling), difficulty in breathing, continuous dry or barking cough, wheezing, wheezing (whistling noise when exhaling). And the cardiovascular system with pallor, cyanosis, tachycardia, lowering of blood pressure and fainting. Immediate and severe allergic reactions are also called anaphylactic reactions or anaphylaxis, and are life-threatening for the baby. In the’allergy with delayed symptoms, these appear several hours after milk intake or even it is not possible to establish a temporal relationship between milk intake and the appearance of allergy manifestations. Symptoms are nonspecific and mainly affect the gastrointestinal system: poor weight gain or loss, irritability with refusal of milk meals, chronic vomiting, chronic mucus or bloody diarrhea, and iron deficiency anemia. Rarely, the skin (moderate-severe atopic dermatitis unresponsive to therapy) and the respiratory system (Heiner’s syndrome) may also be affected ».
What to do when these symptoms occur?
«To ascertain that these symptoms are due to an allergy to cow’s milk proteins, it is necessary to contact a specialist (allergist doctor or allergist pediatrician), who will perform specific tests. Tests include skin allergy tests or skin prick test with standardized extracts (level I test), the search for specific Immunoglobulins E in the blood (level II test) and the oral provocation test in a hospital setting (level III test).
Parents should instead avoid tests without scientific validity and not recognized by scientific societies (e.g. the test for IgG and IgG4, the cytotoxic test or Bryan test or ALCAT-test, the pulse-test, the electrothermal or electroacupuncture test according to Volt, the Vegatest, the Sarmtest, the Bioresonance, the analysis of the hair, the Biostrenghtest, the neutralization test). These tests can delay the diagnosis or lead to the execution of unnecessarily restricted diets with the risk of malnutrition of the child ».
What remedies to adopt once the allergy has been ascertained?
“Whether it’s an allergy with immediate symptoms or one with delayed symptoms, the following applies. The child must scrupulously eliminate cow’s milk from the diet and the foods that contain it. This is because even small amounts of milk can cause symptoms, even severe ones. The specialist doctor will instruct the child’s parents on foods to avoid and provide an action plan for managing any allergic reactions from accidental cow’s milk intake. Children who have experienced severe immediate allergic reactions will also be provided with a self-injectable adrenaline device to manage any anaphylaxis. If the baby feeds on breast milk, the mother can continue breastfeeding. The nursing mother does not need to follow a diet free of cow’s milk and derivatives, except in cases where allergy symptoms have been documented during breastfeeding. If, on the other hand, the baby is taking formula, he must replace it with a special formula, safe for his allergy. There are several types. The first recommended choice is one extensively hydrolyzed cow’s milk formula, except in cases of severe allergic reactions (both immediate and delayed) or immediate symptoms during breastfeeding, where a free amino acid milk is recommended as the first choice. Alternatively, you can use as a second choice milk based on hydrolyzed rice proteins or milk based on soy proteins, starting from 6 months of life and in agreement with the specialist doctor. On the other hand, both partially hydrolysed cow’s milk formulas and the milk of other similar mammals (eg goat’s or sheep’s milk) are contraindicated as artificial milk substitutes, due to the high risk of allergic reactions. Finally, pay attention to avoid as a substitute for formula milk in the first year and preferably in the first two years of life the so-called hypoallergenic vegetable drinks (e.g. almond, coconut, soy drinks) due to the low nutritional intake and the risk of malnutrition of the child.
Finally, it is important to monitor the child’s nutritional status and growth with periodic checks, possibly every three months in the first year of life, then every six months. The doctor will then evaluate the need to provide the child with a calcium and vitamin D supplement, depending on the age requirement and nutritional characteristics of the child’s diet. This integration will also be extended to the nursing mother if a diet free of milk and derivatives is indicated for her “.
How long does cow’s milk allergy last?
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