Food allergy, which refers to food intake, triggers an abnormal immune response in the body, leading to physiological dysfunction, tissue damage and a series of clinical symptoms, such as CMPA caused by the consumption of milk. 0 to 1 year old babies, because the immune system of the intestinal mucosa is not yet mature, are most likely to have allergic reactions to foreign proteins.
Allergic disease in infants is a progressive process and the chance of developing from atopic dermatitis to allergic rhinitis or allergic asthma can be as high as 80%.
Manifestations of cow’s milk protein allergy (CMPA)
Clinical manifestations vary from person to person and are commonly seen as follows.
1. Skin symptoms Pimples, erythema, vesicles, edema, wind-bumps, itching.
2. Gastrointestinal symptoms Vomiting, milk refusal, diarrhea, constipation, blood in stool.
3.Respiratory symptoms Runny nose, otitis media, wheezing, cough, shortness of breath.
4.Eye symptoms Eye itching, tearing, blinking, eye congestion.
5, systemic symptoms Angioneurotic edema of the lips or eyelids; persistent restlessness and abdominal pain ≥ 3 days/week for more than 3 weeks; growth retardation; anaphylactic shock in severe cases.
If other factors such as infection are excluded and one or more of the above symptoms occur at the same time, food allergy should be suspected.
Introduction of special formulas
1. Amino acid formula is made entirely of free amino acids in a certain ratio, without peptide chains, so there is no immunogenicity.
2. Deeply hydrolyzed formula consists of short peptide chains of 2~5 amino acid molecules, which significantly reduces the antigenicity.
3. Partially hydrolyzed formula consists of short and medium peptide chains with more than 18 amino acid molecules, with reduced antigenicity.
4. Soy protein formula Made from soybeans without milk protein, other basic ingredients are the same as conventional formula.
The best way to treat CMPA is to avoid cow’s milk protein and give hypoallergenic formula alternative treatment to provide the energy and nutrition needed for growth.
1. CMPA occurs in artificially fed children. Amino acid formula is preferred, followed by deeply hydrolyzed formula, because about 10% of CMPA infants are intolerant to deeply hydrolyzed formula. The effect can be seen in 2~4 weeks.
If the mother avoids milk and its products and the child’s symptoms improve significantly, the mother can gradually add milk and resume normal diet if the symptoms do not reappear; if the symptoms reappear, the mother should avoid diet during breastfeeding and give deeply hydrolyzed protein formula or amino acid formula after weaning from breast milk. If the symptoms do not recur, the mother should avoid the diet during the breastfeeding period and be given deep hydrolyzed protein formula or amino acid formula after weaning. In children with severe CMPA, if the mother’s diet is not effective, she should be given deep-hydrolyzed protein formula or amino acid formula instead.
3. Precautions
(1) Due to cross-allergic reactions between soy and milk and insufficient nutrient content, soy protein formula is not recommended for treatment.
(2) For other animal milks, considering the nutritional factors and the impact of cross-allergic reactions, it is not recommended to use unhydrolyzed donkey milk and goat milk for substitution treatment.
(3) Partially hydrolyzed formula, although its antigenicity is smaller than that of regular formula, should not be used for treatment.
(4) Cow’s milk protein avoidance usually needs to be continued until 6 months of age, or 9 to 12 months of age, and should be re-evaluated before deciding whether to resume regular diet.
Prognosis of CMPA
The prognosis for CMPA is good, with approximately 55% of infants with CMPA tolerating milk by 1 year of age, >75% by 3 years of age, and >90% by 6 years of age.
Children with CMPA at >2 years of age can be placed on a milk-free diet because of the abundance of food sources to meet their growth and developmental needs.