When it comes to allergies, people generally think of allergic urticaria and asthma caused by contact with some allergens, but in fact, many infants and children are allergic to milk protein. Milk protein allergy does not behave the same way in different age groups of babies.
A. How to check if it is milk protein allergy
1. Skin prick test: Skin prick with fresh milk, similar to the drug skin test. But this method has certain drawbacks, such as possible infection, severe allergic reactions, etc.
2, serum milk-specific IgE antibody determination: is an in vitro test, which means that blood is drawn to check the allergen. If the test result of IgE is significantly higher, milk protein allergy may be considered, and oral milk provocation test is needed to confirm the diagnosis.
Milk avoidance and oral milk stimulation test: Avoid milk and milk products in the diet for 2-4 weeks, if the clinical symptoms improve, consider the possibility of allergy, and then perform an oral milk stimulation test.
Oral milk provocation test also carries certain risks and needs to be performed under close monitoring by professionals with first aid experience, and is time-consuming and laborious.
II. Common manifestations of milk protein allergy
Children who are currently considered to be at high risk for milk protein allergy include those who are atopic themselves, or have other allergic diseases, or have a family history of allergic diseases (such as eczema, asthma, allergic rhinitis, other food allergies, etc.). Milk protein allergy varies in severity and manifests itself differently. Common manifestations are as follows.
1. Gastrointestinal tract: recurrent vomiting, reflux, diarrhea, constipation (with or without perianal rash), blood in the stool, intestinal cramps (which can manifest as recurrent abdominal pain and crying); severe cases can have growth retardation, anemia, enteropathy, ulcerative colitis, etc.
2. Skin: eczema-like manifestations, erythema, wind-bloom, angioedema; severe exudative eczema may be accompanied by infection, growth disorders, iron deficiency anemia, hypoproteinemia, etc.
3.Respiratory system: non-infectious runny nose, chronic cough and wheezing; severe ones can be realized as laryngeal edema, dyspnea, bronchial obstruction, etc.
4. Severe ones can accumulate multiple systems: even blood pressure drop, cardiac arrhythmia and anaphylactic shock, etc.
Treatment of milk protein allergy
The main thing for milk protein allergy is to avoid diet. While avoiding diet, part of the baby needs to be treated with medication, commonly used drugs are glucocorticoids, leukotriene receptor antagonists, antihistamines, and in severe cases, epinephrine. Only dietary management is introduced here.
1, breastfed babies: continue breastfeeding, the mother completely avoid milk and dairy products for at least 2 weeks, for children with allergic colitis, need to continue avoiding for 4 weeks. If the mother avoids milk and dairy products, the baby’s symptoms improve significantly, the mother can add milk, and if the symptoms do not reappear, she can resume normal diet. If symptoms recur, the mother should avoid the diet during breastfeeding and give amino acid formula or deeply hydrolyzed protein formula after weaning from breast milk. Take care of calcium supplements during breastfeeding. In addition, if the avoidance diet fails for breastfed babies, amino acid formula or deeply hydrolyzed protein formula may be required.
2. Cow’s milk fed babies: ≤2 years old babies should completely avoid foods and formulas with cow’s milk protein content and replace them with hypoallergenic formulas such as amino acid formula or deeply hydrolyzed protein formula. ＞Babies >2 years old have abundant food sources to meet their growth and development needs, so they can have a milk-free diet.
(1) Amino acid formula: It does not contain peptides and is made entirely of free amino acids in a certain ratio, so it is not immunogenic. Amino acid formula is recommended for people with milk protein combined with multiple food allergies, non-IgE-mediated gastrointestinal disorders, growth disorders, severe milk protein allergy, and intolerance to deeply hydrolyzed protein formula.
(2) Deeply hydrolyzed protein formula: It is the end product of milk protein formed into dipeptide, tripeptide and a small amount of free amino acids through special processes such as heating, ultrafiltration and hydrolysis, which greatly reduces the spatial conformation and sequence of the unique type of antigenic epitopes of allergens, thus significantly reducing the antigenicity, so it is suitable for most babies with milk protein allergy. A small percentage of milk protein allergic babies cannot tolerate deeply hydrolyzed protein formula, so attention should be paid to any adverse reactions at the beginning.
(3) Soy protein formula: It does not contain milk protein, and the other components are basically the same as conventional formula. However, there are cross-allergic reactions between soy and milk and the nutrient content is insufficient, so it is generally not recommended. It can be used for babies aged >6 months who have financial difficulties and no soy allergy. However, it is not recommended for those with colic.
Milk protein allergy dietary avoidance for at least 3-6 months or age > 9 months still needs to be re-evaluated before deciding to return to a regular diet. For babies with severe milk protein allergy, a continuous avoidance diet is recommended.