Cows Milk Allergy - Allergy, Nutrition

36 Pages·2005·1.23 MB·English

CCooww’’ss MMiillkk AAlllleerrggyy
Janice. M. Joneja, Ph.D. RD
2001
CCooww’’ss MMiillkk AAlllleerrggyy ((CCMMAA))
Associated with a variety of different medical
(cid:122)
conditions
Mechanisms responsible are not all understood
(cid:122)
Include IgE-mediated and non-IgE mediated
(cid:122)
reactions
Known collectively as CMA
(cid:122)
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MMeecchhaanniissmmss RReessppoonnssiibbllee ffoorr CCMMAA
IgE-mediated reactions include classical
(cid:122)
allergy symptoms:
– Urticaria
– Wheezing
Non-IgE-mediated reactions include
(cid:122) :
– Colic
– Vomiting
– Diarrhea
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CCooww’’ss MMiillkk AAlllleerrggyy::
CChhaarraacctteerriissttiiccss
Onset of IgE-mediated reaction
(cid:122)
– Typically immediately following first known
ingestion of cow’s milk
– Sensitization may have occurred earlier due to
exposure to “hidden sources” of cow’s milk (in
breast milk; infant formulae; in utero)
– Diagnosis usually made by parents
Onset is rare in adults
(cid:122)
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CCooww’’ss MMiillkk AAlllleerrggyy
PPrreevvaalleennccee
Prevalence in children
(cid:122) :
– Disagreement because some reports include
both IgE-mediated and non-IgE-mediated
– Others report only ige-mediated
Mechanism not specified:
(cid:122)
– Bock (1987) 0.6%
– Jakobsson and Lindberg (1979): 1 - 2%
– Gerrard (1973) 7.5%
IgE-mediated:
(cid:122)
– Schwartz (1991) 4%
Children with atopic dermatitis:
(cid:122)
– Sampson and Albergo (1989) 20%
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SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr
CCMMAA
[Hill et al, 1986]
Group 1: Immediate Reactors
– Reaction within 45 minutes after milk ingestion
– Symptoms include urticaria, angioedema,
exacerbation of eczema, cough, wheeze,
vomiting
– Skin test positive (STP) to CMA
– Elevated IgE to CMA by RAST or ELISA
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SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr
CCMMAA
Group 2: Intermediate Reactors
– Reaction 45 minutes to 20 hours after
milk ingestion
– Symptoms include vomiting, diarrhea
– Skin test negative to cow’s milk allergens
– Insignificant elevation of IgE to cow’s
milk in RAST or ELISA
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SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr
CCMMAA
Group 3: Late Reactors
– Reaction more than 20 hours after milk
ingestion
– Symptoms include diarrhea, colic, with or
without wheezing, with or without exacerbation
of eczema
– Those with eczema skin test positive to cow’s
milk allergens
– Insignificant elevation of IgE to cow’s milk in
RAST or ELISA
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IIggEE--mmeeddiiaatteedd RReeaaccttiioonn
[Schwartz, 1991]
Typical scenario of first exposure to cow’s milk:
Infant refuses to take more after first taste
(cid:122)
Cries as if in pain
(cid:122)
Swelling of lips, tongue, and mucous membranes
(cid:122)
of throat in 1-2 minutes
May be followed by laryngeal edema (throat
(cid:122)
constriction)
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IIggEE--mmeeddiiaatteedd RReeaaccttiioonn
ccoonnttiinnuueedd
May be accompanied by wheezing
(cid:122)
Occasionally urticaria spreads over entire
(cid:122)
body
In severe cases shock may occur
(cid:122)
Usually spontaneous recovery in 15-60
(cid:122)
minutes
Infant appears exhausted after
(cid:122)
reaction
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