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
3. Infants outgrow their milk allergy; it is not common in older children
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.
[And you will find these
ingredients used in vaccines!!! - bfg] 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%.
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.
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).
[Bovine serum is used as an
ingredient in vaccines. It is listed on the package insert. - bfg]
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.
[And I am willing to bet that your child was vaccinated at the hospital.
(This is a common practice.) The first vaccine has cassein in it which would
make her allergic to the cassein in your milk and in cow's milk. - bfg]
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
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
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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