Back حساسية الحليب Arabic Alergie na bílkovinu kravského mléka Czech Kuhmilchallergie German Alergia a la leche Spanish Lehmapiimavalgu-allergia Estonian آلرژی به شیر Persian Maitoallergia Finnish Allergie au lait French אלרגיה לחלב HE Tejallergia Hungarian

Milk allergy

Not to be confused with Lactose intolerance; see section #Differential diagnosis.

Milk allergy
A glass of cow's milk
SpecialtyEmergency medicine
Allergy & immunology
Symptomsitchiness, rash, swelling of lips, tongue or the whole face, eczema, wheezing and shortness of breath, nausea, vomiting, abdominal pain, diarrhea, anaphylaxis[1]
CausesType I hypersensitivity[2]
Risk factorsChildhood in developed countries where cow's milk infant formula is introduced to supplement or after breast feeding ends[3]
Diagnostic methodMedical history and standard allergy tests[4]
PreventionIntroduction to allergenic foods during infancy[5]
TreatmentEpinephrine[6]
Antihistamines (mild)[7][8]
Prognosisapproximately 20% persist into adulthood[9]
Frequency2–3% in infants,[3] declining to 0.6% in adults[10]

Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Symptoms may take hours to days to manifest, with symptoms including atopic dermatitis, inflammation of the esophagus, enteropathy involving the small intestine and proctocolitis involving the rectum and colon.[2] However, rapid anaphylaxis is possible, a potentially life-threatening condition that requires treatment with epinephrine, among other measures.

In the United States, 90% of allergic responses to foods are caused by eight foods, including cow's milk.[11] Recognition that a small number of foods are responsible for the majority of food allergies has led to requirements to prominently list these common allergens, including dairy, on food labels.[12][13][14][15] One function of the immune system is to defend against infections by recognizing foreign proteins, but it should not overreact to food proteins. Heating milk proteins can cause them to become denatured, losing their three-dimensional configuration and allergenicity, so baked goods containing dairy products may be tolerated while fresh milk triggers an allergic reaction.

The condition may be managed by avoiding consumption of any dairy products or foods that contain dairy ingredients.[3] For people subject to rapid reactions (IgE-mediated milk allergy), the dose capable of provoking an allergic response can be as low as a few milligrams, so such people must strictly avoid dairy.[16][17] The declaration of the presence of trace amounts of milk or dairy in foods is not mandatory in any country, with the exception of Brazil.[13][18][19]

Milk allergy affects between 2% and 3% of babies and young children.[3][20] To reduce risk, recommendations are that babies should be exclusively breastfed for at least four months, preferably six months, before introducing cow's milk. If there is a family history of dairy allergy, then soy infant formula can be considered, but about 10 to 15% of babies allergic to cow's milk will also react to soy.[21] The majority of children outgrow milk allergy, but for about 0.4% the condition persists into adulthood.[22] Oral immunotherapy is being researched, but it is of unclear benefit.[23][24]

  1. ^ Cite error: The named reference medlineplus was invoked but never defined (see the help page).
  2. ^ a b Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P (January 2010). "Cow's milk protein allergy in children: a practical guide". Italian Journal of Pediatrics. 36: 5. doi:10.1186/1824-7288-36-5. PMC 2823764. PMID 20205781.
  3. ^ a b c d Cite error: The named reference EurPed2015rev was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference Soares2014 was invoked but never defined (see the help page).
  5. ^ Ferraro V, Zanconato S, Carraro S (May 2019). "Timing of Food Introduction and the Risk of Food Allergy". Nutrients. 11 (5): 1131. doi:10.3390/nu11051131. PMC 6567868. PMID 31117223.
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  7. ^ "Choosing Wisely: Don't rely on antihistamines as firstline treatment in severe allergic reactions". American Academy of Family Physicians. Archived from the original on 20 October 2021. Retrieved 28 August 2022.
  8. ^ Fineman, SM (July 2014). "Optimal Treatment of Anaphylaxis: Antihistamines Versus Epinephrine". Postgraduate Medicine. 126 (4): 73–81. doi:10.3810/pgm.2014.07.2785. PMID 25141245. S2CID 25203272. Archived from the original on 2022-08-28. Retrieved 2022-09-08.
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  10. ^ Cite error: The named reference Nwaru was invoked but never defined (see the help page).
  11. ^ "Asthma and Allergy Foundation of America". Archived from the original on 6 October 2012. Retrieved 23 December 2012.
  12. ^ "Food Allergen Labeling and Consumer Protection Act of 2004 Questions and Answers". Food and Drug Administration. Archived from the original on 31 October 2017. Retrieved 29 September 2017.
  13. ^ a b "Food Allergies: What You Need to Know". Food and Drug Administration. 18 December 2017. Archived from the original on 25 January 2018. Retrieved 12 January 2018.
  14. ^ Urisu A, Ebisawa M, Ito K, Aihara Y, Ito S, Mayumi M, Kohno Y, Kondo N (September 2014). "Japanese Guideline for Food Allergy 2014". Allergology International. 63 (3): 399–419. doi:10.2332/allergolint.14-RAI-0770. PMID 25178179.
  15. ^ "Food allergen labelling and information requirements under the EU Food Information for Consumers Regulation No. 1169/2011: Technical Guidance" (PDF). April 2015. Archived from the original (PDF) on 2015-09-10 – via Gov.uk.
  16. ^ Taylor SL, Hefle SL (June 2006). "Food allergen labeling in the USA and Europe". Current Opinion in Allergy and Clinical Immunology (Review). 6 (3): 186–90. doi:10.1097/01.all.0000225158.75521.ad. PMID 16670512. S2CID 25204657.
  17. ^ Taylor SL, Hefle SL, Bindslev-Jensen C, Atkins FM, Andre C, Bruijnzeel-Koomen C, et al. (May 2004). "A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?". Clinical and Experimental Allergy (Review. Consensus Development Conference. Research Support, Non-U.S. Gov't). 34 (5): 689–95. doi:10.1111/j.1365-2222.2004.1886.x. PMID 15144458. S2CID 3071478. Archived from the original on 2019-08-09. Retrieved 2019-07-06.
  18. ^ Cite error: The named reference Allen2014 was invoked but never defined (see the help page).
  19. ^ "Guia sobre Programa de Controle de Alergênicos". Agência Nacional de Vigilância Sanitária (in Brazilian Portuguese). 2016. Archived from the original on 29 April 2018. Retrieved 7 April 2018.
  20. ^ Savage, J; Johns, CB (February 2015). "Food allergy: epidemiology and natural history". Immunology and Allergy Clinics of North America. 35 (1): 45–59. doi:10.1016/j.iac.2014.09.004. PMC 4254585. PMID 25459576.
  21. ^ Vandenplas, Y (July 2017). "Prevention and Management of Cow's Milk Allergy in Non-Exclusively Breastfed Infants". Nutrients. 9 (7): 731. doi:10.3390/nu9070731. PMC 5537845. PMID 28698533.
  22. ^ Cite error: The named reference Liu2010 was invoked but never defined (see the help page).
  23. ^ Cite error: The named reference Martorell2014 was invoked but never defined (see the help page).
  24. ^ Brożek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N, et al. (March 2012). "Oral immunotherapy for IgE-mediated cow's milk allergy: a systematic review and meta-analysis". Clinical and Experimental Allergy. 42 (3): 363–74. doi:10.1111/j.1365-2222.2011.03948.x. PMID 22356141. S2CID 25333442.

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