Milk allergy

• What is Milk Allergy?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• How is it Diagnosed
• Prognosis
• Treatment
• References

What is Milk Allergy?

Food allergies can have effects at several different sites in the body, including the mouth, throat, lungs, skin and gastrointestinal tract. Often more than one site in the body is affected at the same time, and the reaction can be generalised, such as anaphylactic shock.

Statistics

In Australia, 1 in 50 infants develop an allergy to milk and other dairy products. About 80% of these children will grow out of this by age 3.

Risk Factors

As with most allergies, children with a family or personal history of allergic disease are more likely to develop dairy allergy.

Progression

In children with a milk allergy, symptoms such as the following may occur:

• Within minutes of ingesting a small amount of milk, symptoms may include hives, eczema, face swelling, vomiting, diarrhoea, noisy breathing or wheeze. In severe reactions, infants may become floppy and develop anaphylaxis.
• Several hours after ingesting a moderate amount of milk, symptoms may include vomiting, diarrhoea and possibly blotchy skin rashes or worsening of eczema.
• Several days after ingesting normal amounts of milk, symptoms can include eczema, vomiting, diarrhoea and asthma.

How is it Diagnosed

There are several methods of unorthodox “tests” for food allergy. Examples include cytotoxic food testing, Vega testing, kinesiology, iridology, pulse testing, Alcat testing and Rinkel’s intradermal skin testing. These are unreliable, have no scientific basis and have no useful role in the assessment of allergy.

Prognosis

As noted above, most infants with milk allergy outgrow their allergy by age 3. Many people with an allergy to milk are also allergic to other foods such as egg, peanut and tree nuts.

Treatment

The best treatment for food allergy is avoidance. Dietary restrictions for milk allergy ideally should be supervised by a dietician as avoiding dairy products in children is not easy and it is important to ensure that adequate intake of nutrients such as calcium is maintained.
In infants with milk allergy the following formulas may be required:

• Soy based formula is tolerated in 50-80% of children with milk allergy, however if your child is also allergic to soy it is not a suitable substitute
• Extensively hydrolysed formula has been treated with enzymes to break down most of the proteins in milk that cause allergy, and they are the supplements of first choice in most milk allergic infants. Some children will still be allergic to still formula and require amino acid based formula
• Amino acid based formula is necessary in 1 in 10 children with milk allergy. It is tolerated by almost all children with soy or milk allergy.

It is important to remember that A2 milk, which is claimed by some to have a number of health promoting properties, will still cause a reaction in people with true milk allergy and is therefore not a suitable substitute. It is important to check the ingredients label on packaged food to determine whether they contain dairy or dairy products. Dairy products may be termed milk, cheese, butter, ghee, butter milk cream, cream fraiche, milk powder, whey, casein, and margarines containing milk products.

References

1. ASCIA patient information bulletin. Dairy allergy. 2004. Available at: http://www.allergy.org.au/aer/infobulletins/milk_allergy.htm
2. ASCIA health professional information bulletin. Dairy allergy. 2004. Available at: http://www.allergy.org.au/aer/infobulletins/hp_allergy_milk.htm
3. James, J. Food Allergies. eMedicine. 2004. Available at: http://www.emedicine.com/med/topic806.htm
4. Warrell, D. Cox, T. Firth, J. Benz, E. Oxford Textbook of Medicine. 4th ed. 2003. Oxford University Press. Oxford.