Cow's Milk Allergy in Children
Allergy to cow's milk is a well-studied form of food allergy. There are both
immediate and delayed patterns of milk allergy. Immediate type allergy tends to
be obvious and shows up on skin tests. Delayed patterns of milk allergy are not
obvious, do not produce positive skin tests and tend to cause chronic disease
that is seldom diagnosed. Cow's milk contains many proteins that are antigenic -
they excite immune responses. People of all ages with gastrointestinal tract disease may have difficulty
digesting these proteins and may absorb them as antigens.
Milk problems may be attributed to lactose intolerance and the milk-sugar enzyme, lactase, may be
prescribed. Milk allergy is a protein problem and is not improved by changing
the milk sugar - often the diagnosis of "lactose intolerance" is incomplete or
wrong and symptoms persist with only lactose exclusion. Often, infant milk
allergy is thought to be a specific and limited condition which children
"outgrow." This idea can be misleading many children continue to have chronic
symptoms from milk, although the original problem may disappear, the pattern of
illness changes and confuses parents and physicians.
Beware of three cow's milk fallacies:
1. Milk allergy can be diagnosed by positive skin allergy tests
2. Lactose intolerance is the main problem with milk and can be easily
solved.
3. Infants outgrow their milk allergy; it is not common in older children and
adults
Infant milk allergy is thought to be a specific and limited condition which
children "outgrow." This idea can be misleading -- many children continue to
have chronic symptoms from milk, although the original problem may disappear,
the pattern of illness changes and confuses parents and physicians. At the very
least, we can say that some children have an allergic tendency that persists and
evolves with different manifestations. Milk allergy is common in adults but is
seldom diagnosed.
In a follow-up study of children with immediate anaphylactic reactions to
cows milk as infants, a prolonged pattern of hypersensitivity was noted with the
development of multiple food and inhalant allergies, multiple hospitalizations
and frequent episodes of drug reactions. These children may continue to manifest
hypersensitivity and grow into adults with immune-mediated diseases. Although
there are few studies which focus on milk-induced disease in adults, there is
enough suggestive evidence to suspect that milk proteins play a major role in
human disease at all ages.
There are at least 30 antigenic primary proteins in milk. Casein is the most
commonly used milk protein in the food industry; lactalbumin, lactoglobulin,
bovine albumin, and gamma globulin are other protein groups within the milk.
Digestion probably increases the number of possible antigens to over 100. Milk
proteins are listed in food products with a variety of names such as milk
solids, skim milk powder, casein, caseinates, whey and albumin. Milk proteins
tend to stay intact as milk is converted to dairy products of all types. While
lactose intolerance may not be an issue with yogurt ingestion, for example, milk
protein allergy remains. Many patients have been fooled by health claims for
lactose-free or lactaid-fixed milk and continue to have symptoms from milk
allergy when they ingest these products. Digested fractions of each of the milk
proteins may induce the production of IgE, IgA, IgM and IgG antibodies and may
trigger complex, variable immune responses. Skin tests with whole milk proteins
are, therefore, misleading - type 1 responses do appear regularly on skin tests
showing IgE activity against intact proteins, but secondary antigens are not
detected.
Furthermore, milk antigens tend to get through the digestive tract intact and
are therefore responsible for delayed immune responses which produce disease in
any and all tissues. These very serious immune responses do not depend on
IgE and do not show up on skin tests. The role of milk proteins in triggering
the most serious pathology usually goes undetected.
Evidence of a pathogenic role of cows milk in many disorders has been
presented - asthma, rhinitis, eczema, urticaria, serous otitis media, pulmonary
alveolitis (hemosiderosis), milk-induced enteropathy in infants, eosinophilic
gastroenteritis, gastrointestinal bleeding with iron deficiency anemia, migraine
headaches, attention deficit hyperactivity disorder, Crohn's disease, rheumatoid
arthritis, and insulin dependent diabetes mellitus.
A major effort has been made by companies manufacturing infant formulas to
produce "hypoallergenic" milk products by various methods of protein hydrolysis.
One study showed whey hydrolysate formula reduced the incidence of eczema in the
first year of life in infants at risk; 21.8% of infants on whey hydrolysate
presented symptoms compared with 48.6%. Formulas with partially hydrolyzed
protein have not been as 'safe" as manufacturers had hoped and promised as
Carnation found out after they marketed their "Good Start" infant formula and
many allergic reactions including anaphylaxis were reported. In animal models,
Jarret had demonstrated that small doses of cow's milk antigens are more
sensitizing than larger doses.
The IgE model of allergy is attractive to researchers, because of its
simplicity and the ease of testing for sensitization; but, it selects only a
special population of people with Type 1, IgE-mediated allergy. While this is an
important reaction pattern, some physicians have claimed it is the only valid
form of allergic reactions to food. Their opinion is not acceptable. A
distinction between immediate, obvious allergic reactions and delayed, less
obvious, chronic immune injury is useful.
Diabetes Model Because of evidence that cow's milk intake can trigger
diabetes in rodents, a study of diabetic children showed that antibodies to
bovine serum albumin and a 17-amino-acid bovine serum albumin peptide (ABBOS).
These antibodies would bind to a pancreatic beta-cell surface antigen. This
study showed that diabetic patients had high serum concentrations of anti-BSA
antibodies (IgA and IgG). The presence of antibody ( which means presence of
antigen-specific B-cells) may signal the concomitant presence of
antigen-specific cytotoxic T-lymphocytes, although these have not yet be
demonstrated. The researchers suggest that ... "relevant clones ( of
lymphocytes) are continuously transferred from immature IgM-expressing B-cell
compartments to pools of IgG-secreting or IgA secreting cells" They go on to
describe "... a slow inefficient process, consistent with the fact that clinical
disease develops in only about 5 to 6 % of hosts with the relevant genetic
predisposition."
The diabetes model of food-antigen triggered disease is a potentially
important immunological model of many unsolved diseases which appear to be
"autoimmune". A long-term, inefficient pathogenesis which may produce
target-organ damage, especially if the antigen is provided by a common food and
intake continues over many years. Alternative explanations suggest that beta
cells are attacked by cytotoxic T-cells after they are infected by a virus, or
by T-cells originally targeted on other cells infected by virus whose
cell-surface antigens happen to resemble beta cell antigens.
An Australian study of children who developed diabetes found that children
given cows milk formula in the first three months were 52% more likely to
develop diabetes than those not fed milk. Breast fed infants had a 34% lower
incidence of diabetes than formula fed infants.
Problem Solving Example My daughter was born this past summer.
She was four weeks early and spent 11 days in an intensive care unit.
After leaving the hospital, she came home for 8 days. Then she returned to
the hospital because she was pooping a foam-like substance. The doctor
determined that she was missing the lactase enzyme because of her prematurity
and I was encouraged to continue to breast-feed, treat the milk with lactaid
drops, and feed it to her through a bottle...which I have done. Recently
we noticed blood in her stool. We saw the doctor who collected various
stool samples and blood tests, all of which came back negative. His conclusion
was that she must be allergic to the cow's milk protein. I was put on a
dairy free diet immediately, which I have now been on for over 2 weeks. I
have had no milk, cheese, yogurt, ice cream, and have checked the labels on
everything. Interestingly enough, she still has blood in her stool!!!
We are frustrated!!! I guess I am wondering if I should be cutting out
beef, certain fish, eggs, or something else that may be triggering this??
The problem is, I do not know what I can and cannot eat anymore and no one seems
to be able to give me answers. How do I keep my strength up when
there is nothing I can eat? Could this also be a wheat allergy? The
blood is bright red when it comes out and my daughter does not seem like she is
in excruciating pain....not yet, anyway. We want to find out what is going
on! She is five months old. Can you help? We tried giving her
rice cereal just before the first noticeable bleeding incident, but discontinued
that after this happened. She really only had it four times.
Any help you can give would be great!! Meal plans, suggestions, what is a
milk-free diet?
Response Cow's milk allergy does cause intestinal bleeding in infants. Other
food allergy may contribute. You are breast feeding and small amounts of
proteins from your diet appear in your breast milk. While milk proteins are the
number 1 suspects, wheat, meat and egg proteins are also high risk. You
need to modify your diet until your daughter's symptoms clear.
Our standard approach is to recommend that you retreat to phase 1 foods in
the Alpha Nutrition Program for more than 10 days or until your daughter's
symptoms subside completely. You would then reintroduce phase 2 foods slowly.
This is explained in the book Feeding Children and the Alpha Nutrition Program.
You can order the Children's starter pack which combines books and some ENF
formula. The formula will boost your nutrient intake. When she is better, you
can slowly introduce phase 1 foods to build a diet for her.
Learn how you can solve food-related problems with a balanced,
scientifically-based strategy of diet revision, the Alpha Nutrition Program.
Several problems interact in a complex manner to produce the symptoms and
dysfunction that we seek to remedy.
