Symptoms
The possible symptoms of cow’s milk allergy include:
- Itching and a furry feeling in the mouth and throat, swelling, nausea, vomiting, diarrhea (including blood in the stool), abdominal pain
- Skin rash, often around the mouth, urticaria (hives), eczema, flushing.
- Whistling, wheezing breathing, cough.
- Runny nose, nasal itching, nasal congestion.
- Allergic conjunctivitis
The symptoms may occur immediately or with a time delay. In the worst case, cow’s milk allergy can cause life-threatening and generalized anaphylaxis.
Causes
Milk allergy is an allergic reaction to the milk protein found in milk, especially casein and beta-lactoglobulin. Milk allergy occurs mainly in infants and young children and is rare in adulthood. Those who are allergic to cow’s milk often also show allergy to other types of milk and have a predisposition. The allergy may be IgE-mediated and/or cellular (non-IgE) mediated.
Diagnosis
Diagnosis is made by medical treatment on the basis of the patient’s history, clinical symptoms, and with allergy tests (skin test, blood test for IgE antibodies, provocation test). Lactose intolerance must be excluded. Lactose intolerance is not an allergy.
Nonpharmacologic treatment
For prevention, milk, dairy products, and processed products containing milk protein should be avoided. It is important to keep in mind that milk contains important nutrients, vitamins, and minerals. The omission of milk can lead to an undersupply and growth retardation. Therefore, special infant milks with hydrolyzed proteins or with amino acids are available for allergic infants. Using milk from other mammals is often not a solution because cross-reactions often occur. Soy milk is also not recommended. Children usually outgrow the allergy by the age of three and subsequently tolerate milk. Therefore, regular medical follow-up and re-exposure to milk are recommended.
Drug treatment
For acute drug treatment, antiallergic drugs such as antihistamines or glucocorticoids may be used. Inhalable beta2-sympathomimetics, such as salbutamol, may facilitate breathing if breathing is difficult. For treatment of anaphylaxis, epinephrine is the first-line agent. Prefilled epinephrine syringes are available that parents can carry and self-administer to children in an emergency.
