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AuthorStephen Gislason MD
Cow's Milk Allergy in Children
Allergy to cow's milk is a well-studied form of food allergy. There are both immediate and delayed patterns of milk allergy. Immediate type allergy tends to be obvious and shows up on skin tests. Delayed patterns of milk allergy are not obvious, do not produce positive skin tests and tend to cause chronic disease that is seldom diagnosed. Cow's milk contains many proteins that are antigenic - they excite immune responses.
People of all ages with gastrointestinal tract disease may have difficulty digesting these proteins and may absorb them as antigens. Milk problems may be attributed to lactose intolerance and the milk-sugar enzyme, lactase, may be prescribed. Milk allergy is a protein problem and is not improved by changing the milk sugar - often the diagnosis of "lactose intolerance" is incomplete or wrong and symptoms persist with only lactose exclusion.
Beware of three cow's milk fallacies:
1.Milk allergy can be diagnosed by positive skin allergy tests
2. Lactose intolerance is the main problem with milk and can be easily solved.
3. Infants outgrow their milk allergy; it is not common in older children and adults
Infant milk allergy is thought to be a specific and limited condition which children "outgrow." This idea can be misleading -- many children continue to have chronic symptoms from milk, although the original problem may disappear, the pattern of illness changes and confuses parents and physicians. At the very least, we can say that some children have an allergic tendency that persists and evolves with different manifestations. Milk allergy is common in adults but is seldom diagnosed.
In a follow-up study of children with immediate anaphylactic reactions to cows milk as infants, a prolonged pattern of hypersensitivity was noted with the development of multiple food and inhalant allergies, multiple hospitalizations and frequent episodes of drug reactions. These children may continue to manifest hypersensitivity and grow into adults with immune-mediated diseases. Although there are few studies which focus on milk-induced disease in adults, there is enough suggestive evidence to suspect that milk proteins play a major role in human disease at all ages.
There are at least 30 antigenic primary proteins in milk. Casein is the most commonly used milk protein in the food industry; lactalbumin, lactoglobulin, bovine albumin, and gamma globulin are other protein groups within the milk. Digestion probably increases the number of possible antigens to over 100. Milk proteins are listed in food products with a variety of names such as milk solids, skim milk powder, casein, caseinates, whey and albumin. Milk proteins tend to stay intact as milk is converted to dairy products of all types. While lactose intolerance may not be an issue with yogurt ingestion, for example, milk protein allergy remains. Many patients have been fooled by health claims for lactose-free or lactaid-fixed milk and continue to have symptoms from milk allergy when they ingest these products. Digested fractions of each of the milk proteins may induce the production of IgE, IgA, IgM and IgG antibodies and may trigger complex, variable immune responses. Skin tests with whole milk proteins are, therefore, misleading - type 1 responses do appear regularly on skin tests showing IgE activity against intact proteins, but secondary antigens are not detected.
Furthermore, milk antigens tend to get through the digestive tract intact and are therefore responsible for delayed immune responses which produce disease in any and all tissues. These very serious immune responses do not depend on IgE and do not show up on skin tests. The role of milk proteins in triggering the most serious pathology usually goes undetected.
Evidence of a pathogenic role of cows milk in many disorders has been presented - asthma, rhinitis, eczema, urticaria, serous otitis media, pulmonary alveolitis (hemosiderosis), milk-induced enteropathy in infants, eosinophilic gastroenteritis, gastrointestinal bleeding with iron deficiency anemia, migraine headaches, attention deficit hyperactivity disorder, Crohn's disease, rheumatoid arthritis, and insulin dependent diabetes mellitus.
A major effort has been made by companies manufacturing infant formulas to produce "hypoallergenic" milk products by various methods of protein hydrolysis. One study showed whey hydrolysate formula reduced the incidence of eczema in the first year of life in infants at risk; 21.8% of infants on whey hydrolysate presented symptoms compared with 48.6%. Formulas with partially hydrolyzed protein have not been as 'safe" as manufacturers had hoped and promised as Carnation found out after they marketed their "Good Start" infant formula and many allergic reactions including anaphylaxis were reported. In animal models, Jarret had demonstrated that small doses of cow's milk antigens are more sensitizing than larger doses.
The IgE model of allergy is attractive to researchers, because of its simplicity and the ease of testing for sensitization; but, it selects only a special population of people with Type 1, IgE-mediated allergy. While this is an important reaction pattern, some physicians have claimed it is the only valid form of allergic reactions to food. Their opinion is not acceptable. A distinction between immediate, obvious allergic reactions and delayed, less obvious, chronic immune injury is useful.
Diabetes Model Because of evidence that cow's milk intake can trigger diabetes in rodents, a study of diabetic children showed that antibodies to bovine serum albumin and a 17-amino-acid bovine serum albumin peptide (ABBOS). These antibodies would bind to a pancreatic beta-cell surface antigen. This study showed that diabetic patients had high serum concentrations of anti-BSA antibodies (IgA and IgG). The presence of antibody ( which means presence of antigen-specific B-cells) may signal the concomitant presence of antigen-specific cytotoxic T-lymphocytes, although these have not yet be demonstrated. The researchers suggest that ... "relevant clones ( of lymphocytes) are continuously transferred from immature IgM-expressing B-cell compartments to pools of IgG-secreting or IgA secreting cells" They go on to describe "... a slow inefficient process, consistent with the fact that clinical disease develops in only about 5 to 6 % of hosts with the relevant genetic predisposition."
The diabetes model of food-antigen triggered disease is a potentially important immunological model of many unsolved diseases which appear to be "autoimmune". A long-term, inefficient pathogenesis which may produce target-organ damage, especially if the antigen is provided by a common food and intake continues over many years. Alternative explanations suggest that beta cells are attacked by cytotoxic T-cells after they are infected by a virus, or by T-cells originally targeted on other cells infected by virus whose cell-surface antigens happen to resemble beta cell antigens.
An Australian study of children who developed diabetes found that children given cows milk formula in the first three months were 52% more likely to develop diabetes than those not fed milk. Breast fed infants had a 34% lower incidence of diabetes than formula fed infants.
Problem Solving Example My daughter was born this past summer. She was four weeks early and spent 11 days in an intensive care unit. After leaving the hospital, she came home for 8 days. Then she returned to the hospital because she was pooping a foam-like substance. The doctor determined that she was missing the lactase enzyme because of her prematurity and I was encouraged to continue to breast-feed, treat the milk with lactaid drops, and feed it to her through a bottle...which I have done. Recently we noticed blood in her stool. We saw the doctor who collected various stool samples and blood tests, all of which came back negative. His conclusion was that she must be allergic to the cow's milk protein. I was put on a dairy free diet immediately, which I have now been on for over 2 weeks. I have had no milk, cheese, yogurt, ice cream, and have checked the labels on everything. Interestingly enough, she still has blood in her stool!!! We are frustrated!!! I guess I am wondering if I should be cutting out beef, certain fish, eggs, or something else that may be triggering this?? The problem is, I do not know what I can and cannot eat anymore and no one seems to be able to give me answers. How do I keep my strength up when there is nothing I can eat? Could this also be a wheat allergy? The blood is bright red when it comes out and my daughter does not seem like she is in excruciating pain....not yet, anyway. We want to find out what is going on! She is five months old. Can you help? We tried giving her rice cereal just before the first noticeable bleeding incident, but discontinued that after this happened. She really only had it four times. Any help you can give would be great!! Meal plans, suggestions, what is a milk-free diet?
Response Cow's milk allergy does cause intestinal bleeding in infants. Other food allergy may contribute. You are breast feeding and small amounts of proteins from your diet appear in your breast milk. While milk proteins are the number 1 suspects, wheat, meat and egg proteins are also high risk. You need to modify your diet until your daughter's symptoms clear.
Our standard approach is to recommend that you retreat to phase 1 foods in the Alpha Nutrition Program for more than 10 days or until your daughter's symptoms subside completely. You would then reintroduce phase 2 foods slowly. This is explained in the book Feeding Children and the Alpha Nutrition Program. You can order the Children's starter pack which combines books and some ENF formula. The formula will boost your nutrient intake. When she is better, you can slowly introduce phase 1 foods to build a diet for her.
Learn how you can solve food-related problems with a balanced, scientifically-based strategy of diet revision, the Alpha Nutrition Program. Several problems interact in a complex manner to produce the symptoms and dysfunction that we seek to remedy.
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Helping Children Website was developed by Alpha Education, a division of Environmed Research Inc. Sechelt, B.C., Canada. Online Since 1995. Experts in Self-Managed Care. Experts in Elemental Nutrient Formulas. The topics online were adapted from 2 books, Feeding Children and Children and Family, written by Stephen Gislason MD. The latest editions were released in 2015. The Alpha Nutrition Program is required reading when diet revision is required to solve children's diseases. Alpha Nutrition is a registered trademark of Environmed Research Inc.
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