Milk allergy
Encyclopedia
A milk allergy is a food allergy
, an adverse immune reaction
to one or more of the constituents of milk from any animal (most commonly alpha S1-casein, a protein
in cow's milk
). This milk-induced allergic reaction can involve anaphylaxis
, a potentially life-threatening condition.
It is important to note that a milk allergy is a separate and distinct condition from lactose intolerance
.
s within milk. The most common one is alpha S1-casein.
Alpha S1-caseins differ between species. This explains why someone with an allergic reaction to sheep's milk cannot drink goat's milk but can drink breast milk without an allergic reaction.
, and gastric distress
such as diarrhea
, constipation
, stomach pain
or flatulence
. The clinical spectrum extends to diverse disorders: anaphylactic reactions
, atopic dermatitis
, wheeze
, infantile colic
, gastroesophageal reflux (GER), oesophagitis, allergic colitis
, headache
/migraine
, oral irritation, and constipation
.
The symptoms may occur within a few minutes after exposure in immediate reactions, or after hours (and in some cases after several days) in delayed reactions.
, an adverse immune reaction to a food protein that is normally harmless to the non-allergic individual. Lactose intolerance
is a non-allergic food sensitivity, and comes from a lack of production of the enzyme
lactase
, required to digest the predominant sugar in milk. Adverse effects of lactose intolerance generally occur after much higher levels of milk consumption than do adverse effects of milk allergy.
(Lactose intolerance is considered the normal state for most adults on a worldwide scale and is not typically considered to be a disease condition.)
It is commonplace for milk or milk derivatives to be included in processed foods such as bread, crackers, cookies, cakes, prepared meats, "soy cheese", soups, gravies, crisps, margarine, and products labeled "non-dairy", such as whipped topping and creamer (non-dairy simply means less than 0.5% milk by weight).
It is also commonplace for milk derivatives, like casamino acid, to be in vaccines.
In some cases, heating the dairy product to force an exothermic chemical reaction can denature the proteins, (i.e. baking bread, or other baked goods). Only the ingredients that are chemically reacting will denature.
It is important to note that many processed foods that do not contain milk may be processed on equipment contaminated with dairy foods, which may cause an allergic reaction in some sensitive individuals.
formulas are used to provide a complete source of nutrition. Milk substitutes include soy based formulas, hypoallergenic formulas based on partially or extensively hydrolyzed
protein, and free amino acid-based formula
s.
Non-milk derived amino acid-based formulas, known as amino acid formulas or elemental formulas, are considered the gold standard in the treatment of cows milk allergy when the mother is unable to breastfeed.
Hydrolyzed formulas come in partially hydrolyzed and extensively hydrolyzed varieties. Partially hydrolyzed formulas (PHFs) are characterized by a larger proportion of long chain peptides and are considered more palatable. However, they are intended for milder cases and are not considered suitable for treatment of moderate to severe milk allergy or intolerance. Extensively hydrolyzed formulas (EHFs) are composed of proteins that have been largely broken down into free amino acids and short peptides. Casein and whey are the most commonly used sources of protein in hydrolyzed formulas because of their high nutritional quality and their amino acid composition.
Soy based formula may or may not pose a risk of allergic sensitivity, as some infants who are allergic to milk may also be allergic to soy. Also soy based formula are not recommended for infants under 6 months. However, for infants with multiple allergies there are rice milk
or oat milk based formulas available.
, soy milk
, oat milk, coconut milk
and almond milk
are sometimes used as milk substitutes but are not suitable nutrition for infants. However, special infant formula
based on soy, rice
, almond
s or carob seeds is commercially available.
On an avoidance diet, it may be possible to reduce the longer-term risk of calcium deficiency and osteoporosis by incorporating other sources of calcium, although the effect of calcium and vitamin D supplementation on osteoporosis is not always clear. There are fruit juices supplemented with calcium, sesame seeds, hemp seeds
and some kinds of tofu
. They may, however, have other effects on health.
such as Diphenhydramine
(Benadryl) are prescribed by an allergist in case of accidental ingestion. Milk allergy can cause anaphylaxis
, a severe, life threatening allergic reaction.
Milk allergies are common in infants but are usually outgrown within the first 2–3 years of life.
Between 13% and 20% of children allergic to milk are also allergic to beef.
Food allergy
A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions....
, an adverse immune reaction
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
to one or more of the constituents of milk from any animal (most commonly alpha S1-casein, a protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
in cow's milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
). This milk-induced allergic reaction can involve anaphylaxis
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
, a potentially life-threatening condition.
It is important to note that a milk allergy is a separate and distinct condition from lactose intolerance
Lactose intolerance
Lactose intolerance, also called lactase deficiency or hypolactasia, is the inability to digest and metabolize lactose, a sugar found in milk...
.
Allergen
A person with milk allergy can be reactive to one of dozens of the proteinProtein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
s within milk. The most common one is alpha S1-casein.
Alpha S1-caseins differ between species. This explains why someone with an allergic reaction to sheep's milk cannot drink goat's milk but can drink breast milk without an allergic reaction.
Symptoms
The principal symptoms are gastrointestinal, dermatological and respiratory. These can translate to: skin rash, hives, vomitingVomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, and gastric distress
Distress (medicine)
In medicine, distress is an aversive state in which an animal is unable to adapt completely to stressors and their resulting stress and shows maladaptive behaviors...
such as diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
, stomach pain
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
or flatulence
Flatulence
Flatulence is the expulsion through the rectum of a mixture of gases that are byproducts of the digestion process of mammals and other animals. The medical term for the mixture of gases is flatus, informally known as a fart, or simply gas...
. The clinical spectrum extends to diverse disorders: anaphylactic reactions
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
, atopic dermatitis
Atopic dermatitis
Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder...
, wheeze
Wheeze
A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, or airflow velocity within the respiratory tree must be heightened...
, infantile colic
Baby colic
Colic is a condition in which an otherwise healthy baby cries or displays symptoms of distress frequently and for extended periods, without any discernible reason...
, gastroesophageal reflux (GER), oesophagitis, allergic colitis
Colitis
In medicine, colitis refers to an inflammation of the colon and is often used to describe an inflammation of the large intestine .Colitides may be acute and self-limited or chronic, i.e...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
/migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, oral irritation, and constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
.
The symptoms may occur within a few minutes after exposure in immediate reactions, or after hours (and in some cases after several days) in delayed reactions.
Difference between milk allergy and lactose intolerance
Milk allergy is a food allergyFood allergy
A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions....
, an adverse immune reaction to a food protein that is normally harmless to the non-allergic individual. Lactose intolerance
Lactose intolerance
Lactose intolerance, also called lactase deficiency or hypolactasia, is the inability to digest and metabolize lactose, a sugar found in milk...
is a non-allergic food sensitivity, and comes from a lack of production of the enzyme
Enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
lactase
Lactase
Lactase , a part of the β-galactosidase family of enzymes, is a glycoside hydrolase involved in the hydrolysis of the disaccharide lactose into constituent galactose and glucose monomers...
, required to digest the predominant sugar in milk. Adverse effects of lactose intolerance generally occur after much higher levels of milk consumption than do adverse effects of milk allergy.
(Lactose intolerance is considered the normal state for most adults on a worldwide scale and is not typically considered to be a disease condition.)
Difference from milk protein intolerance
Milk protein intolerance (MPI) is delayed reaction to a food protein that is normally harmless to the non-allergic, non-intolerant individual. Milk protein intolerance produces a non-IgE antibody and is not detected by allergy blood tests. Milk protein intolerance produces a range of symptoms very similar to milk allergy symptoms, but can also include blood and/or mucus in the stool. Treatment for milk protein intolerance is the same as for milk allergy. Milk protein intolerance is also referred to as milk soy protein intolerance (MSPI).It is commonplace for milk or milk derivatives to be included in processed foods such as bread, crackers, cookies, cakes, prepared meats, "soy cheese", soups, gravies, crisps, margarine, and products labeled "non-dairy", such as whipped topping and creamer (non-dairy simply means less than 0.5% milk by weight).
It is also commonplace for milk derivatives, like casamino acid, to be in vaccines.
In some cases, heating the dairy product to force an exothermic chemical reaction can denature the proteins, (i.e. baking bread, or other baked goods). Only the ingredients that are chemically reacting will denature.
It is important to note that many processed foods that do not contain milk may be processed on equipment contaminated with dairy foods, which may cause an allergic reaction in some sensitive individuals.
Milk avoidance and replacement for infants
Since milk protein may be transferred from a breastfeeding mother to an allergic infant, lactating mothers are simply put on a dairy elimination diet. For formula fed infants, milk substituteMilk substitute
A milk substitute is a liquid that replaces milk in a diet or recipe. This overlaps with but is distinct from the group of milk-like liquids called "milks" because of their similarity to the liquid produced by mammary glands....
formulas are used to provide a complete source of nutrition. Milk substitutes include soy based formulas, hypoallergenic formulas based on partially or extensively hydrolyzed
Hydrolysis
Hydrolysis is a chemical reaction during which molecules of water are split into hydrogen cations and hydroxide anions in the process of a chemical mechanism. It is the type of reaction that is used to break down certain polymers, especially those made by condensation polymerization...
protein, and free amino acid-based formula
Amino acid-based formula
An amino acid-based formula, also known as an elemental formula, is a type of hypoallergenic infant formula made from individual amino acids. Amino acids are the building blocks of protein and together they form the protein requirements in formula needed for growth and development...
s.
Non-milk derived amino acid-based formulas, known as amino acid formulas or elemental formulas, are considered the gold standard in the treatment of cows milk allergy when the mother is unable to breastfeed.
Hydrolyzed formulas come in partially hydrolyzed and extensively hydrolyzed varieties. Partially hydrolyzed formulas (PHFs) are characterized by a larger proportion of long chain peptides and are considered more palatable. However, they are intended for milder cases and are not considered suitable for treatment of moderate to severe milk allergy or intolerance. Extensively hydrolyzed formulas (EHFs) are composed of proteins that have been largely broken down into free amino acids and short peptides. Casein and whey are the most commonly used sources of protein in hydrolyzed formulas because of their high nutritional quality and their amino acid composition.
Soy based formula may or may not pose a risk of allergic sensitivity, as some infants who are allergic to milk may also be allergic to soy. Also soy based formula are not recommended for infants under 6 months. However, for infants with multiple allergies there are rice milk
Rice milk
Rice milk is a kind of grain milk processed from rice. It is mostly made from brown rice and commonly unsweetened. The sweetness in most rice milk varieties is generated by a natural enzymatic process, cleaving the carbohydrates into sugars, especially glucose, similar to the Japanese amazake...
or oat milk based formulas available.
Milk substitution for children and adults
There are many commercially available replacements for milk for children and adults. Rice milkRice milk
Rice milk is a kind of grain milk processed from rice. It is mostly made from brown rice and commonly unsweetened. The sweetness in most rice milk varieties is generated by a natural enzymatic process, cleaving the carbohydrates into sugars, especially glucose, similar to the Japanese amazake...
, soy milk
Soy milk
Soy milk and sometimes referred to as soy drink/beverage is a beverage made from soybeans. A stable emulsion of oil, water, and protein, it is produced by soaking dry soybeans and grinding them with water...
, oat milk, coconut milk
Coconut milk
Coconut milk is the water that comes from the grated meat of a coconut. The colour and rich taste of the milk can be attributed to the high oil content. In many parts of the world, the term coconut milk is also used to refer to coconut water, the naturally occurring liquid found inside the hollow...
and almond milk
Almond milk
Almond milk is a milky drink made from ground almonds. Unlike animal milk, almond milk contains no cholesterol or lactose. Regular, unsweetened almond milk can be used as a substitute for animal milk in many recipes, and as it does not contain any animal products, is suitable for vegetarians and...
are sometimes used as milk substitutes but are not suitable nutrition for infants. However, special infant formula
Infant formula
Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid . The U.S...
based on soy, rice
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
, almond
Almond
The almond , is a species of tree native to the Middle East and South Asia. Almond is also the name of the edible and widely cultivated seed of this tree...
s or carob seeds is commercially available.
On an avoidance diet, it may be possible to reduce the longer-term risk of calcium deficiency and osteoporosis by incorporating other sources of calcium, although the effect of calcium and vitamin D supplementation on osteoporosis is not always clear. There are fruit juices supplemented with calcium, sesame seeds, hemp seeds
Hemp
Hemp is mostly used as a name for low tetrahydrocannabinol strains of the plant Cannabis sativa, of fiber and/or oilseed varieties. In modern times, hemp has been used for industrial purposes including paper, textiles, biodegradable plastics, construction, health food and fuel with modest...
and some kinds of tofu
Tofu
is a food made by coagulating soy milk and then pressing the resulting curds into soft white blocks. It is part of East Asian and Southeast Asian cuisine such as Chinese, Japanese, Korean, Indonesian, Vietnamese, and others. There are many different varieties of tofu, including fresh tofu and tofu...
. They may, however, have other effects on health.
Accidental exposure
Treatment for accidental ingestion of milk products by allergic individuals varies depending on the sensitivity of the allergic person. Frequently medications such as an Epinephrine pen or an AntihistamineAntihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
such as Diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
(Benadryl) are prescribed by an allergist in case of accidental ingestion. Milk allergy can cause anaphylaxis
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
, a severe, life threatening allergic reaction.
Milk allergies are common in infants but are usually outgrown within the first 2–3 years of life.
Statistics
Milk allergy is the most common food allergy in early childhood. It affects somewhere between 2% and 3% of infants in developed countries, but approximately 85–90% of affected children lose clinical reactivity to milk once they surpass 3 years of age.Between 13% and 20% of children allergic to milk are also allergic to beef.
See also
- AllergyAllergyAn Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
- AnaphylaxisAnaphylaxisAnaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
- Dairy productDairy productDairy products are generally defined as foods produced from cow's or domestic buffalo's milk. They are usually high-energy-yielding food products. A production plant for such processing is called a dairy or a dairy factory. Raw milk for processing comes mainly from cows, and, to a lesser extent,...
- Human-milk bankHuman-milk bankA human milk bank is a service which collects, screens, processes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant.See also: Human milk banking in North America...
- Lactose intoleranceLactose intoleranceLactose intolerance, also called lactase deficiency or hypolactasia, is the inability to digest and metabolize lactose, a sugar found in milk...
- List of allergies
- Medical emergencies
External links
- A muffin a day could keep milk allergy at bay
- Eating without Casein Practical guide to milk-free eating
- Milk Allergy at Food Allergy InitiativeFood Allergy InitiativeThe Food Allergy Initiative is a 501 non-profit organization founded in 1998 with the mission to fund food allergy research that seeks a cure, to improve diagnosis and treatment, and to keep patients safe through advocacy and education. FAI is the largest private source of funding for food...
- Milk Allergy Symptoms