CCooww’’ss MMiillkk AAlllleerrggyy Janice. M. Joneja, Ph.D. RD 2001 CCooww’’ss MMiillkk AAlllleerrggyy ((CCMMAA)) Associated with a variety of different medical (cid:122) conditions Mechanisms responsible are not all understood (cid:122) Include IgE-mediated and non-IgE mediated (cid:122) reactions Known collectively as CMA (cid:122) 2 MMeecchhaanniissmmss RReessppoonnssiibbllee ffoorr CCMMAA IgE-mediated reactions include classical (cid:122) allergy symptoms: – Urticaria – Wheezing Non-IgE-mediated reactions include (cid:122) : – Colic – Vomiting – Diarrhea 3 CCooww’’ss MMiillkk AAlllleerrggyy:: CChhaarraacctteerriissttiiccss Onset of IgE-mediated reaction (cid:122) – Typically immediately following first known ingestion of cow’s milk – Sensitization may have occurred earlier due to exposure to “hidden sources” of cow’s milk (in breast milk; infant formulae; in utero) – Diagnosis usually made by parents Onset is rare in adults (cid:122) 4 CCooww’’ss MMiillkk AAlllleerrggyy PPrreevvaalleennccee Prevalence in children (cid:122) : – Disagreement because some reports include both IgE-mediated and non-IgE-mediated – Others report only ige-mediated Mechanism not specified: (cid:122) – Bock (1987) 0.6% – Jakobsson and Lindberg (1979): 1 - 2% – Gerrard (1973) 7.5% IgE-mediated: (cid:122) – Schwartz (1991) 4% Children with atopic dermatitis: (cid:122) – Sampson and Albergo (1989) 20% 5 SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr CCMMAA [Hill et al, 1986] Group 1: Immediate Reactors – Reaction within 45 minutes after milk ingestion – Symptoms include urticaria, angioedema, exacerbation of eczema, cough, wheeze, vomiting – Skin test positive (STP) to CMA – Elevated IgE to CMA by RAST or ELISA 6 SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr CCMMAA Group 2: Intermediate Reactors – Reaction 45 minutes to 20 hours after milk ingestion – Symptoms include vomiting, diarrhea – Skin test negative to cow’s milk allergens – Insignificant elevation of IgE to cow’s milk in RAST or ELISA 7 SSuuggggeesstteedd CCllaassssiiffiiccaattiioonn SScchheemmee ffoorr CCMMAA Group 3: Late Reactors – Reaction more than 20 hours after milk ingestion – Symptoms include diarrhea, colic, with or without wheezing, with or without exacerbation of eczema – Those with eczema skin test positive to cow’s milk allergens – Insignificant elevation of IgE to cow’s milk in RAST or ELISA 8 IIggEE--mmeeddiiaatteedd RReeaaccttiioonn [Schwartz, 1991] Typical scenario of first exposure to cow’s milk: Infant refuses to take more after first taste (cid:122) Cries as if in pain (cid:122) Swelling of lips, tongue, and mucous membranes (cid:122) of throat in 1-2 minutes May be followed by laryngeal edema (throat (cid:122) constriction) 9 IIggEE--mmeeddiiaatteedd RReeaaccttiioonn ccoonnttiinnuueedd May be accompanied by wheezing (cid:122) Occasionally urticaria spreads over entire (cid:122) body In severe cases shock may occur (cid:122) Usually spontaneous recovery in 15-60 (cid:122) minutes Infant appears exhausted after (cid:122) reaction 10