MILK (INCLUDING LACTOSE)

Cow’s milk allergy

Cow’s milk allergy is likely to occur from birth and is common in young children, with 3-6 in every 100 infants and young children having this allergy (Allergy UK 2015) Fortunately most children grow out of it by the age of 5 years old (Allergy UK 2015) and it is much less common in adults A reaction can be caused by eating/drinking milk even through touching or smelling milk (e.g. in a coffee shop). Reactions through touch and smell are only usually serious if milk gets into the body in some way, e.g. through broken skin (Anaphylaxis Campaign 2016) It is an immune system reaction to the protein(s) found in cow’s milk If a person reacts to cow’s milk proteins, they are also likely to react to other mammalian milks (e.g. sheep, goat, buffalo) as the protein structures are very similar There are 2 types of cow’s milk allergy:

1. Immediate cow’s milk allergy:
   • This is well understood by doctors and health professionals
   • The reaction is ‘immediate’ as in seconds or minutes
   • It is an immune system reaction to the protein(s) found in cow’s milk
   • Can be life-threatening
   • Once a child is diagnosed, an allergy action plan should be agreed between the doctor and you/your child. This may include treatments such as oral antihistamines, inhalers or adrenaline if the child is at risk of anaphylaxis (Anaphylaxis Campaign 2016)
2. Delayed cow’s milk allergy
   • It usually occurs in  infants, especially if they are exclusively bottle-fed
   • The reaction is ‘delayed’ as in it can take several hours or even days
   • It is not as well understood as immediate cow’s milk allergy as it is hard to diagnose because of the delay in symptoms. Testing is also difficult and the allergy often mimics other conditions (such as colic, digestive difficulties and eczema)
   • Not usually life-threatening
   • Delayed cow’s milk allergy requires different treatment to immediate cow’s milk allergy
   • The only way to diagnose delayed cow’s milk allergy is to work closely with doctors and dietitians and remove milk (and everything containing it) from the child’s diet for a few weeks. The Anaphylaxis Campaign (2016) specifies 4-6 weeks, but this conflicts with advice from The Milk Allergy in Primary Care (MAP) Guidelines (2013) which states 2-4 weeks. This demonstrates why a health professional needs to oversee the diagnosis and elimination diet. Milk will then be reintroduced and if there is still a reaction a dietitian will advise on the next steps (Anaphylaxis Campaign 2016)

Cow’s milk allergy:

• Swelling of the lips, tongue and sometimes the throat which can be fatal (anaphylaxis). This can also occasionally cause a fall in blood pressure leading to collapse (immediate cow’s milk allergy only)
• Diarrhoea
• Stomach/bowel problems (including bloating and discomfort)
• Nausea and vomiting
• Difficulty breathing – especially if the person has asthma – and can include wheezing and coughing (immediate cow’s milk allergy only)
• Reflux, vomiting, colic, refusing or disliking being fed (delayed cow’s milk allergy)
• Constipation and/or a red bottom (delayed cow’s milk allergy only)
• Blood or mucus in the stools (delayed cow’s milk allergy only)
• Itchy skin rash (hives)/eczema
• Nose feeling blocked up/congested
• Behavioural feeding difficulties
• Unintentional weight loss

British Nutrition Foundation (2015) & Anaphylaxis Campaign (2016)