Cow milk protein allergy is the most common milk protein allergy. Incidences are 2-5% among formula fed infants and 1.4-0.5 % among breastfed infants. Incidences of soy protein allergy are 0.25%.
Types of milk protein allergy
Milk protein allergy is of two types:-
- Ig-E mediated allergy (Type 1 hypersensitivity reaction)
- Non-Ig-E mediated allergy (Type 3 and type 4 hypersensitivity reaction)
Ig E mediated allergy:
Ig-E mediated hypersensitivity occurs when antigen binds to Ig-E antibodies. Which causes degranulation of mast cells and release of histamine. Histamine is a potent inflammatory mediator and responsible for immediate allergic reaction.
Non-Ig E mediated allergy:
Non-Ig-E mediated allergy is multifactorial. Immune complexes of IgA or IgG antibodies in children are the main culprit. When these immune complexes of IgA or IgG antibodies bind with the milk antigens there is release of cytokines. Milk protein also directly stimulates T cells leads to increase in the production of antibodies that recognize offending milk proteins.
Symptoms:
Respiratory system- cough, wheeze
Skin- urticaria, rash, pruritus
Gastrointestinal system- gastroesophageal reflux, esophagitis, gastritis, delayed gastric emptying, enteropathy, colitis, constipation
Nutritional – failure to thrive, weight loss
Behavioural- inconsolable crying, feed refusal
Investigations:
Skin prick test, Serum Ig-E level, Patch test, serum albumin level, blood platelets count, C- reactive protein, erythrocyte sedimentation rate, stool leukocytes.
Investigations are non-diagnostic.
Treatment:
Avoidance of allergen and maintaining a balanced nutrition to provide adequate calories, macro and micro nutrients.
Q and A:
Que-1. Can cow milk be given to the infant of CMPA?
Ans- No.
Que-2. Can buffalo milk be given to the infant of CMPA?
Ans- No.
Que-3. Can any dairy product be given to the infant of CMPA?
Ans- None.
Que-4. Which formula milk can be given to the infant of CMPA?
Ans- Partially hydrolysed formula milk, extremely hydrolysed formula milk and amino acid formula milk.
Que-5. Is cow milk protein allergy treatable?
Ans- Yes.