Milk protein intolerance
| Milk allergy | |
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| A glass of cow's milk | |
| Specialty | emergency medicine |
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Milk allergy is an adverse immune reaction to one or more of the protein constituents of cow's milk. Symptoms can be rapid or gradual in onset. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. The latter can take hours to days to appear. Presentations may include atopic dermatitis, inflammation of the esophagus, enteropathy involving the small intestine and involving the rectum and colon.
In the United States, 90% of allergic responses to foods are caused by eight foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans. Allergy to cow's milk is the most common. The U.S. Food Allergen Labeling and Consumer Protection Act of 2004 requires that the label of a food that contains an ingredient that is or contains protein from these eight major food allergens declare the presence of the allergen on the label. Dairy foods are also on the mandatory labeling list in Japan and the European Union.
Prevention is by avoiding eating dairy foods and foods that contain dairy ingredients. Infants should be breastfed for at least four months, preferably six months before introduction of cow's milk based infant formula. If there is a family history of dairy allergy then an extensively hydrolyzed cow's milk formula is recommended. Soy infant formula can be considered, but about 10 to 15% of infants allergic to cow's milk will also react to soy. In the United States, milk allergy has a prevalence between 2% and 3% in infants and young children. The majority of people outgrow milk allergy, but some remain allergic as adults. Strong predictors for adult-persistence are anaphylaxis, high milk-specific serum immunoglobulin E (IgE), robust response to the skin prick test and absence of tolerance to milk-containing baked foods. Oral immunotherapy to induce tolerance is being researched, but a consensus on implementation into clinical practice guidelines has not been reached.
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