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MILK ALLERGY

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MILK ALLERGY

Milk allergy is a common condition, particularly in infants and young children.

Causes

Milk allergy arises from an immune system reaction to one or more proteins in cow’s milk. The two primary proteins responsible are casein and whey. When a person with a milk allergy consumes these proteins, their immune system mistakenly identifies them as harmful, triggering an allergic response.

Prevalence

Milk allergy is one of the most prevalent food allergies in children, affecting about 2-3% of children under the age of three. Fortunately, many children outgrow this allergy by the time they reach adolescence. However, it can persist into adulthood in some cases.

Milk Allergy and Other Animal Milk

Consult with your doctor about the safety of sheep and goat’s milk if you have a milk allergy. In most cases, individuals allergic to cow’s milk will also react to sheep and goat’s milk due to the similarity in proteins. These proteins can trigger the same allergic reactions.

Milk Allergy vs. Lactose Intolerance

It’s essential to understand the difference between a milk allergy and lactose intolerance, as they are not the same:

  • Milk Allergy
    • Immune System Reaction: In milk allergies, the immune system mistakenly identifies milk proteins as harmful and releases histamines, causing symptoms.
    • Symptoms: These can include wheezing, vomiting, diarrhea, hives, and anaphylaxis.
    • Trigger Proteins: The proteins in cow’s milk, as well as similar proteins in sheep and goat’s milk, typically cause reactions in those with milk allergies.
  • Lactose Intolerance
    • Digestive Issue: This occurs when the body lacks lactase, the enzyme needed to digest lactose (milk sugar).
    • Symptoms: Common symptoms include stomach pain, gas, and diarrhea.
    • Tolerance Variability: People with lactose intolerance might tolerate small amounts of dairy or lactose-free products.

Symptoms

Symptoms of milk allergy can vary from mild to severe and may appear within minutes to hours after consuming milk. Common symptoms include:

  • Hives
  • Wheezing
  • Vomiting
  • Diarrhea
  • Abdominal cramps
  • Runny nose
  • Watery eyes

In severe cases, milk allergy can cause anaphylaxis, a life-threatening reaction that requires immediate medical attention.

Risk Factors

Several factors can increase the risk of developing a milk allergy:

  • Family History: If parents or siblings have allergies or asthma, the risk increases.
  • Age: Milk allergy is more common in children than adults.
  • Other Allergies: Children with other food allergies or atopic conditions, such as eczema, are more likely to develop a milk allergy.

Diagnosis

Diagnosing milk allergy involves a combination of methods:

  1. Medical History: Detailed discussion about symptoms and family history of allergies.
  2. Skin Prick Test: A small amount of milk protein is introduced to the skin to observe for a reaction.
  3. Blood Test: Measures the immune system’s response to milk protein by checking for specific antibodies.
  4. Elimination Diet: Removing milk from the diet to see if symptoms improve.
  5. Oral Food Challenge: Consuming small amounts of milk under medical supervision to observe for reactions.

Treatments

The primary treatment for milk allergy is avoiding milk and milk-containing products. However, accidental exposure can happen, and it’s essential to know how to manage reactions:

  • Antihistamines: Help alleviate mild allergic symptoms like hives and runny nose.
  • Epinephrine Auto-Injector: For severe reactions, such as anaphylaxis, immediate use of an epinephrine injector is crucial.

Home Care Tips

1. Nutritional Balance
  • Alternative Sources: Incorporate broccoli, spinach, and soy products into your diet to replace the calcium, protein, and vitamins D and B12 typically obtained from dairy.
  • Dietitian Support: Consult with a registered dietitian to create a balanced meal plan that meets your nutritional needs without dairy.
2. Dairy Substitutes
  • Milk Alternatives: Use fortified soy, rice, oat, and almond milks.
  • Non-Dairy Products: Look for non-dairy ice cream, chocolate, cheese, and yogurt options.
  • Butter Alternatives: Choose margarines made with vegetable oil instead of butter.
  • Buttermilk Substitute: Mix a tablespoon of vinegar into a cup of rice milk or soy milk.
3. Label Vigilance
  • Kosher Products: Be cautious with kosher items labeled “pareve,” as they may still contain milk proteins.
  • Unlabeled Foods: Avoid foods from salad bars, deli counters, and bakeries, as they might contain allergens.
  • Regular Label Reading: Always read ingredient labels, even for products you purchase regularly, as formulations can change.
4. Special Considerations
  • Infant Formula: If your baby has a milk allergy, ask your pediatrician about using extensively hydrolyzed, casein-based formula.
  • Non-Food Items: Check labels on cosmetics, creams, ointments, and medicines for milk-derived ingredients like whey.

Practical Tips

  1. Home Cooking: Prepare meals at home to control ingredients and avoid accidental exposure.
  2. Educate Yourself: Learn about hidden sources of milk in processed foods and non-food items.
  3. Plan Ahead: When eating out, inform the restaurant staff about your allergy and inquire about the ingredients used.
  4. Emergency Preparedness: Carry antihistamines or an epinephrine injector if prescribed, and have a plan for accidental exposure.
  5. Community Support: Join support groups or online forums to share experiences and tips with others managing milk allergies.
  6. Inform Others: Ensure caregivers, teachers, and friends are aware of the allergy and know how to respond in case of an emergency.

Prevention

While it’s not possible to prevent a milk allergy from developing, some strategies might help reduce the risk:

  • Breastfeeding: Exclusive breastfeeding for the first six months can reduce the risk of developing allergies.
  • Introduction of Solid Foods: Introducing allergenic foods, including milk, in a controlled manner under the guidance of a pediatrician.

Products to Avoid

Dairy products

If you have a milk allergy, it’s important to avoid these dairy products:

  • Butter and butter fat
  • Cheese (including cottage cheese and cheese sauces)
  • Cream (including sour cream)
  • Custard
  • Milk (including buttermilk, powdered milk, and evaporated milk)
  • Yogurt
  • Ice cream
  • Pudding
Foods That Often Contain Milk

These foods often have cow’s milk protein. Always check labels and ask about ingredients when eating out:

  • Au gratin dishes and white sauces
  • Baked goods (bread, cookies, crackers, cakes)
  • Battered and fried foods
  • Cake mix
  • Cereals
  • Chewing gum
  • Chocolate and cream candy
  • Coffee creamers
  • Creamed or scalloped foods
  • Donuts
  • Granola bars
  • Gravies
  • Indian food (ghee is common)
  • Malted milk
  • Margarine
  • Mashed potatoes
  • Processed meats (canned, cold cuts, deli meats)
  • Nougat (found in some candy)
  • Salad dressings
  • Sherbet
Ingredients That Contain Milk Proteins

Be cautious of these ingredients on labels, as they indicate the presence of milk proteins:

  • Artificial butter or cheese flavor
  • Casein or caseinates
  • Diacetyl
  • Curd
  • Ghee
  • Hydrolysates
  • Lactalbumin, lactalbumin phosphate
  • Lactose, lactoglobulin, lactoferrin, lactulose
  • Protein powders
  • Recaldent
  • Rennet
  • Tagatose
  • Whey or whey products

When to See a Doctor

Seek medical advice if you or your child exhibits symptoms of milk allergy, especially if:

  • Symptoms persist or worsen.
  • There is a family history of allergies or asthma.
  • Severe reactions, such as difficulty breathing, occur.

Outlook/Prognosis

The prognosis for milk allergy is generally positive. Many children outgrow it by age three, and those who don’t often see a reduction in severity. With careful management and adherence to dietary restrictions, individuals with milk allergy can lead healthy, active lives.

Sources

  • Mayo Clinic: Milk Allergy
  • WebMD
  • American Academy of Allergy, Asthma & Immunology
  • KidsHealth: Milk Allergy
  • National Institute of Allergy and Infectious Diseases

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