What to do in case of milk allergy

  • Gryboski JD (1967) Gastrointestinal milk allergy in infants. Pediatrics 40: 354-362. [Crossref]
  • Powell GK (1976) Enterocolitis in low-birth-weight infants associated with milk and soy protein intolerance. J Pediatr 88: 840-844. [Crossref]
  • McDonald PJ, Powell GK, Goldblum RM (1982) Serum D-xylose absorption tests: reproducibility and diagnostic usefulness in food-induced enterocolitis. J Pediatr Gastroenterol Nutr 1: 533-536. [Crossref]
  • Ruffner M, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, et al.

    (2013) Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol 1: 343-349. [Crossref]

  • Feuille E, Nowak-Wegrzyn A (2014) Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 14: 222-228. [Crossref]
  • Mane SK, Bahna SL (2014) Clinical manifestations of food protein-induced enterocolitis síndrome. Curr Opin Allergy Clin Immunol 14: 217-221. [Crossref]
  • Mori F, Barr S, Cianteroni A, Pucci N, de Martino M, Novembre E (2009) Cytokine expression in CD3+ cells in an baby with food protein-induced enterocolitis síndrome (FPIES): case report.

    Clin Dev Immunol. 6: 79-81. [Crossref]

  • Ikola RA (1963) Severe intestinal reaction following ingestion of rice. Am J Dis Child 105: 281-284. [Crossref]
  • Sicherer SH, Eigenmann PA, Sampson HA (1998) Clinical features of food protein- induced enterocolitis syndrome. J Pediatr 133: 214-219. [Crossref]
  • Caminti L, Salzano G, Crisafulli G, et al. (2014) Food protein induced enterocolitis syndrome caused by rice beverage. Italian Journal of Pediatrics 3: 39-31. [Crossref]
  • Miceli Sopo S, Greco M, Monaco S, Tripodi S, Calvani M (2013) Food protein-induced enterocolitis syndrome, from practice to theory.

    Expert Rev Clin Immunol 9: 707-715. [Crossref]

There’s no cure for lactose intolerance, but most people are capable to control their symptoms by making changes to their diet.

Some cases of lactose intolerance, such as those caused by gastroenteritis, are only temporary and will improve within a few days or weeks.

Other cases, such as those caused by an inherited genetic fault or a long-term underlying condition, are likely to be long-lasting.

There’s no cure for lactose intolerance, but most people are capable to control their symptoms by making changes to their diet.

Some cases of lactose intolerance, such as those caused by gastroenteritis, are only temporary and will improve within a few days or weeks.

Other cases, such as those caused by an inherited genetic fault or a long-term underlying condition, are likely to be long-lasting.


Case report

The patient was a female baby of 2 months of age who has an significant family history of atopy, she has a brother with the diagnosis of athopic dermatitis, who had profuse vomiting and diarrhea with cow’s milk based formula, but tolerate soy based formula.

She was nourished with breast milk postnatally, but at the age of 5 days of birth, when her mom stop breastfeeding her and introduced cow’s milk based formula started with profuse repetitive vomiting and watery diarrhea.

What to do in case of milk allergy

Because of those symptoms, mom changed the formula to rice base formula; since diarrhea persisted, even though vomiting had stopped, the formula was change to soy based one. At this point, she presented mild improvement of diarrhea, but new symptoms had appeared like: abdominal pain and mucus in her stools. She arrived to the Emergency unit with dehydratation, abdominal distention, irritability, increased abdominal movement, pain during exploration, diarrhea with green watery mucus no bloody stools. The blood test reported anemia, neutrophilia, and thrombocytosis (Table 1); stool analysis reported abundant mucus, occult blood and leukocytes (Table 1) including metabolic acidosis (Table 1).

At this time, our diagnosis was cow’s milk allergy and started treatment with extensively hydrolyzed formula, but the patient persisted with watery diarrhea and abdominal distention. The radiologic imaging showed distended little bowel, increased bowel loops, intramural gas and poliedric images (Figure 1), new blood test still with anemia, eosinophilia, leukocitosis and thrombocytosis (Table 1) Allergy test negative (Table 1).

After the persistence of the symptoms, we considered the diagnosis of food protein-induced enterocolitis syndrome (FPIES) and after 72 hours of changing the treatment to an aminoacidic formula; the baby was finally hydratated, returned to acid-base equilibrium, diarrhea stopped and had nutritional acquire based on her weight improvement.



So numerous foods are made with milk and milk products these days that people with milk allergies own to pay attention to what’s in just about everything they eat.

And a milk allergy is not the same as lactose intolerance — some people with food allergies can become suddenly and severely ill if they eat or even come in contact with the food they’re allergic to.

Some foods that contain milk are obvious, love pizza. But others, love baked goods, might not be so obvious. Plus, teens need calcium and vitamin D, which milk has lots of, because their bones are still growing.

So what should a person who’s allergic to milk do? Read on to discover out.

How Is It Treated?

To treat a milk allergy, the person who is allergic needs to completely avoid any foods that contain milk or milk products.

Avoiding milk involves more than just leaving the cheese off your sandwich.

If you are allergic to milk, you need to read food labels carefully and not eat anything that you’re not certain about. It’s a excellent thought to work with a registered dietitian to develop an eating plan that provides every the nutrients you need while avoiding things you can’t eat.

If you own a severe milk allergy — or any helpful of serious allergy — your doctor may desire you to carry a shot of epinephrine (pronounced: eh-peh-NEH-frin) with you in case of an emergency.

Epinephrine comes in an easy-to-carry container about the size of a large marker. It’s simple to use — your doctor will show you how.

If you accidentally eat something with milk in it and start having serious allergic symptoms — love swelling inside your mouth, chest pain, or difficulty breathing — give yourself the shot correct away to counteract the reaction while you’re waiting for medical assist. Always call for emergency assist (911) when using epinephrine.

What to do in case of milk allergy

You should make certain your school and even excellent friends’ houses hold injectable epinephrine on hand, too.

Keeping epinephrine with youat every times should be just part of your action plan for living with a milk allergy. It’s also a excellent thought to carry an over-the-counter antihistamine, which can assist ease allergy symptoms in some people. But antihistamines should be used in addition to the epinephrine, not as a replacement for the shot.

If you’ve had to take an epinephrine shot because of an allergic reaction, go immediately to a medical facility or hospital emergency room so they can give you additional treatment if you need it.

What to do in case of milk allergy

Sometimes, anaphylactic reactions are followed bya second wave of symptoms a fewhours later. So you might need to be watched in a clinic or hospital for 4 to 8 hours following the reaction.

What Is a Milk Allergy?

When a baby is allergic to milk, it means that his or herimmune system, which normally fights infections, overreacts to proteins in cow’s milk. Every time the kid has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals love .

Cow’s milk is in most baby formulas.

Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants own a lower risk of having a milk allergy than formula-fed babies.

People of any age can own a milk allergy, but it’s more common in young children. Numerous kids outgrow it, but some don’t.

If your baby has a milk allergy, hold two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

What Are the Signs & Symptoms of a Milk Allergy?

In children who show symptoms shortly after they own milk, an allergic reaction can cause:

  1. hoarseness
  2. vomiting
  3. stomach upset
  4. wheezing
  5. hives
  6. trouble breathing
  7. swelling
  8. coughing
  9. diarrhea
  10. itchy, watery, or swollen eyes
  11. throat tightness
  12. a drop in blood pressure causing lightheadedness or loss of consciousness

The severity of allergic reactions to milk can vary.

The same kid can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.

Children also can have:

  1. an intolerance to milk in which symptoms — such as loose stools, blood in the stool, refusal to eat, or irritability or colic — appear hours to days later
  2. lactose intolerance, which is when the body has trouble digesting milk

If you’re not certain if your kid has an intolerance versus an allergy, talk to your doctor.

What Happens With a Milk Allergy?

Food allergies involve the body’s immune system, which normally fights infection.

When someone is allergic to a specific food, the immune system overreacts to proteins in that food.

People who are allergic to cow’s milk react to one or more of the proteins in it. Curd, the substance that forms chunks in sour milk, contains 80% of milk’s proteins, including several called caseins (pronounced: KAY-seenz). Whey (pronounced: WAY), the watery part of milk, holds the other 20%. A person may be allergic to proteins in either or both parts of milk.

Every time the person eats these proteins, the body thinks they are harmful invaders.

The immune system responds by kicking into high gear to fend off the «invader.» This causes an allergic reaction, in which chemicals love histamine are released in the body.

The release of these chemicals can cause someone to own the following problems:

  1. hoarseness
  2. vomiting
  3. diarrhea
  4. wheezing
  5. hives
  6. trouble breathing
  7. swelling
  8. throat tightness
  9. stomachache
  10. red spots
  11. itchy, watery, or swollen eyes
  12. coughing
  13. a drop in blood pressure

Milk allergy is love most food allergy reactions: It generally happens within minutes to hours after eating foods that contain milk proteins.

Although it’s not common, milk allergies can cause a severe reaction called anaphylaxis.

Anaphylaxis may start with some of the same symptoms as a less severe reaction, but then quickly worsen. A person might own trouble breathing, feel lightheaded, or pass out. If it’s not treated, anaphylaxis can be life-threatening.

Milk allergy is often confused with lactose intolerance because people can own the same kinds of things happening to them (like stomach pains or bloating, for example) with both conditions. But they’re not related:

  1. Milk allergy is a problem involving the immune system.
  2. Lactose intolerance involves the digestive system (which doesn’t produce enough of the enzyme needed to break below the sugar in milk).

If Your Kid Has an Allergic Reaction

If your kid has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.

If your kid has symptoms of a serious reaction (like swelling of the mouth or throat or difficulty breathing, or symptoms involving two diverse parts of the body, love hives with vomiting):

  1. Give the epinephrine auto-injector correct away.

    Every second counts in an allergic reaction.

  2. Then,call 911 or take your kid to the emergency room. Your kid needs to be under medical supervision because, even if the worst seems to own passed, a second wave of serious symptoms can happen.

How Can Doctors Tell It’s a Milk Allergy?

If your doctor suspects you might own a milk allergy, he or she will probably refer you to an allergist or allergy specialist for more testing. The allergy specialist will enquire you questions — love how often you own the reaction, the time it takes between eating a specific food and the start of the symptoms, and whether any family members own allergies or conditions love eczema and asthma.

The allergy specialist may do a skin test on you.

This involves placing liquid extracts of milk protein on your forearm or back, pricking the skin a tiny bit, and waiting to see if a reddish, raised spot forms, indicating an allergic reaction.

You may need to stop taking anti-allergy medications (such as over-the-counter antihistamines) or prescription medicine 5 to 7 days before the skin test because they can affect the results. Most freezing medicines and some antidepressants also may affect skin testing. Check with the allergist’s office if you are unsure about what medications need to be stopped and for how long.

The doctor also might take a blood sample and send it to a lab, where it will be mixed with some of the suspected allergen and checked for IgE antibodies.

These types of tests are used for diagnosing what doctors call a fast-onset type of milk allergy.

But for people whose allergic reactions to milk develop more slowly, skin and blood tests are not as helpful.

In these cases, doctors attempt to diagnose the person using a food challenge. The person is told not to eat or drink anything made with milk for a period of time — generally a few weeks. Then, during the challenge, the person eats foods containing milk under a doctor’s shut supervision. If symptoms come back after eating milk products, it’s a beautiful certain bet the person has a milk allergy.

How Is a Milk Allergy Diagnosed?

If you ponder your baby is allergic to milk, call your baby’s doctor.

What to do in case of milk allergy

He or she will enquire you questions and talk to you about what’s going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist (a doctor who specializes in treating allergies).

The allergist might do skin testing. In skin testing, the doctor or nurse will put a tiny bit of milk protein on the skin, then make a little scratch on the skin. If your kid reacts to the allergen, the skin will swell a little in that area love an insect bite.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Living With a Milk Allergy

It can be challenging to eliminate milk from your diet, but it’s not impossible.

Because most people don’t get enough calcium in their diets even if they do drink milk, numerous other foods are now enriched with calcium, such as juices, cereals, and rice and soy beverages. But before you eat or drink anything calcium-enriched, make certain it’s also dairy-free.

Milk and milk products can lurk in strange places, such as processed lunchmeats, margarine, baked goods, artificial butter flavor, and non-dairy products. Chocolate is another product that may contain dairy — so be certain to check the label before you eat it.

Manufacturers of foods sold in the United States must list on their labels whether a food contains any of the most common allergens.

What to do in case of milk allergy

This means that you should be capable to discover the expression «milk» stated plainly in the ingredients list, in parentheses in the ingredients list, or somewhere on the label with a statement like: «Contains milk.»

It is optional, however, for food manufacturers to use «may contain» statements. The U.S. Food and Drug istration does not control whether companies can tell things love «Processed in a facility that also processes milk products» or «May contain milk.» So call the manufacturer to be certain if you see statements love this on a food label.

New labeling requirements make it a little easier than reading the ingredients list — instead of needing to know that the ingredient «hydrolyzed casein» comes from milk protein, you should be capable to tell at a glance which foods to avoid.

But it’s still a excellent thought to get to know the «code words» for milk products when you see them in the ingredients of a food.

Some ingredients and foods that contain milk are:

  1. dairy products love cheese, yogurt, milk, pudding, sour cream, and cottage cheese
  2. lactalbumin, lactoalbumin phosphate, lactaglobulin, lactose, lactoferrin, lactulose
  3. butter, butter flavoring (such as diacetyl), butter fat, butter oil, ghee
  4. casein, calcium casein, casein hydrolysate, magenesium casein, potassium casein, rennet casein, sodium casein
  5. non-dairy creamers
  6. whey, whey hydrolysate

Vegan foods are made without animal products, such as eggs or milk.

You can purchase vegan products at health food stores. Be careful to read the labels of soy cheeses, though. They may tell «milk-free» but could contain milk protein.

For your sweet tooth, soy- or rice-based frozen desserts, sorbets, and puddings are excellent substitutes for ice cream (as endless as you’re not allergic to soy), as are ice pops. For baking, milk substitutes work as well as milk and some come out better. Dairy-free margarine works as well as butter for recipes and spreading on your bagel.

Try to avoid fried foods or foods with batter on them.

What to do in case of milk allergy

Even if the batter doesn’t contain milk products, the oil used to fry the foods may own been used to fry something that contains milk.

People are generally understanding when it comes to food allergies — nobody wants to risk your health. When dining out, tell the waitstaff about anything you’re allergic to. Order the simplest foods and enquire the waitstaff detailed questions about menu items. At a friend’s home, explain your situation and don’t be embarrassed to enquire questions if you’re staying for a meal.

Having a milk allergy doesn’t mean you can’t still enjoy eating.

In fact, some people ponder that some of the milk substitutes — love vanilla soy milk — taste better than regular cow’s milk. As with any specialized diet, you’ll probably discover that avoiding milk gives you the chance to explore and discover some grand foods that you’d never own found otherwise!

en españolAlergia a la leche en bebés

Avoiding a Milk Allergy Reaction

If You’re Breastfeeding

If your breastfed baby has a milk allergy, talk to the allergist before changing your diet.

If You’re Formula Feeding

If you’re formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formulaor an amino acid-based formula in which the proteins are broken below into particles so that the formula is less likely to trigger an allergic reaction.

You also might see "partially hydrolyzed" formulas, but these aren’t truly hypoallergenic and can lead to a significant allergic reaction.

If you’re concerned about a milk allergy, it’s always best to talk with your child’s doctor and work together to select a formula that’s safe for your baby.

Do not attempt to make your own formula.

Commercial formulas are approved by the U.S. Food and Drug istration (FDA) and created through a extremely specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older kid with a milk allergyare not safe for infants.

If you own any questions or concerns, talk with your child’s doctor.

Abstract

Food protein induced enterocolitis syndrome (FPIES) is characterized by severe gastrointestinal and systemic symptoms related to dietary protein due to gastrointestinal inflammation and increased permeability of the gastrointestinal mucosa, the typical presentation of an acute event is vomiting followed by diarrhea, dehydration and lethargy.

The diagnosis is mainly established with clinical history and oral challenge test; the latter should be omitted in case of severe symptoms and improvement of symptoms by elimination diet. We report the case of SEIPD in a female baby fed with formulas based on cow's milk, soy and rice with symptoms resolution after the introduction of elemental formula.


Summary

Enterocolitis syndrome induced by dietary protein (SEIPD) is characterized by severe gastrointestinal and systemic symptoms related to dietary protein due to gastrointestinal inflammation and increased permeability of the gastrointestinal mucosa, the typical presentation of an acute event is vomiting followed by diarrhea, dehydration and lethargy.

The diagnosis is mainly established with clinical history and oral challenge test; the latter should be omitted in case of severe symptoms and to an improvement of symptoms by elimination diet. We report the case of a female baby of 2 months of age fed formulas based on cow's milk, soy and rice that showed symptoms of post- SEIPD with the introduction of the elemental formula recovery.


Introduction

The food protein induced-enterocolitis syndrome (FPIES) is characterized by gastrointestinal and severe systemic symptoms that are generally caused by gastrointestinal inflammation and increased mucosal permeability related to the proteins ingested through the diet, the acute clinical presentation is vomiting, diarrhea, lethargy and dehydratation.

Vomiting is reported in 95% of every cases and occurs 2 hours average after ingestion of the offending food [1], meanwhile diarrhea is reported between 20-50% of every patients. Generally is a non IgE-mediated food hypersensitivity and in almost 90% of every patients the prick test are negative, test results report increased neutrophil count, eosinophilia, anemia, increased platelet count, hipoalbuminemia and metabolic acidosis. Abdominal images show diverse patterns depending on the severity of the symptoms, they own report dystension, thickening of the walls of the intestine, intramural gas, which could seem love a gastrointestinal obstruction or a necrotizing enterocolitis [2].

The first case series of FPIES caused by cow’s milk formulas in neonates was published in the 60’s [3], at the same time IKOLA had published a case of an baby with acute rice and wheat FPIES after the introduction of these foods to the diet [4] and described that the difference between patients with allergic proctocolitis, is that patients with enterocolitis simply don’t glance excellent.

Almost 10 years later POWELL described a cohort of neonates feed with cow’s milk formulas that present abdominal distention, hypothermia, peripherial blood neutrophilia and presence of inflammatory cells in stools (linphocytes, neutrophils, eosinophils) [5,6].

Gryboski [3] and Powell [4] report that some infants present profuse vomiting and diarrhea with cardiovascular collapse and neutrophilia generally 2 hours after ingestion of the food. The term food protein-induced enterocolitis (FPIE) was first coined by McDonald [7], recognizing cow milk/soy protein likely triggered the reaction.

Sicherer [5] suggested the disorder be called a síndrome, recognizing the disease was characterized by a constellation of shared clinical and laboratory features thus FPIE became FPIES.


Discussion

The food protein-induced enterocolitis syndrome (FPIES) must be consider not just a disease cause by cow’s milk proteins and has to be taken into consideration when you are in front of a patient that has persistent symptoms even though the nutritional changes that literature propose to be done.

The persistence of symptoms indicates us, a bad choice in the therapeutic algorithim of the multiple aspects of this disease.

Their are a lot of proteins that can cause FPIES, being the most común cow’s milk proteins, soy and rice. The phisiopathological mechanism is not well understood, but some authors own propuse some hypothesis to explain this desease, one of the most acepted one is the activation of the T cells by food allergens, which creates intestinal inflammation, that contributes to increase the local permeability, where TNF-α has an significant contribution, including the decrease expresión of the receptors 1 of the TGF-β in the intestinal mucosa, which activates mononuclear cells.

In some recient studies, they own found the presence of an increase IL-4 and a decrease number of INF-γ of the T cell.

Their are no especific clinic symptoms of the desease, even though, MICELI SOPO et al in 2013 propused some criteria to aid the clinician in diagnosis, which include the following: 1) less tan 2 years of age at first presentation (not mandatory); 2) exposure to trigger food licits repetitive vomiting, pallor, and lethargy within 2-4 h, and generally final less tan 6h; 3) absence of symptoms that propose an IgE-mediated reaction; 4) avoidance of offending protein from the diet results in resolution of symptoms; and 5) recurrence of typical symptoms within 2-4 h of reexposure.

What to do in case of milk allergy

An International Working Group on Consensus Guidelines for FPIES has been formed under the auspices of the AAAAI Adverse Reactions to Food Committee and the International Association of Food Protein-induced Enterocolitis in 2013. The expert panel is working on evidence-based guidelines for diagnosis and management of FPIES to improve the care provided for the patients with FPIES.

What to do in case of milk allergy

Until today, is useful to use the medical history and an oral food challenge (OFC) to establish the diagnosis of FPIES; however, when the history indicates that the patient own experienced severe symptoms or multiple reactions to the same food, a diagnosis may be based on a convincing history and absence of symptoms when the causative food is eliminated from the diet.

These case, open the diagnostic posibilities for the Pediatrician and the Gastroenterologist, which are in contact with this type of patients, in orther to focus the therapeutic conduct towards the elimination of the possible food agents that can cause FPIES.

Exclusively breastfeeding until 4-6 months and avoiding the introduction of other food proteins, it is one of the most significant preventive measures in orther to decrease complications in infants who own FPIES.

It is significant to ponder about the posible diagnosis of FPIES in a patient with no clasical gastrointestinal symptoms of food allergy, when they start after the introduction of new proteins to the diet and that those symptoms does not improve with other formulas (soy, rice, etc…).

Research and further investigation most be done in orther to develop an evidence-based approach to criteria diagnosis and management of FPIES.


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