Milk protein allergy in infants is a recognized problem in the first year of life; The allergy to cow’s milk protein is the most common allergy. The diagnosis is only suspected in history, and laboratory studies play a secondary role. Confirmation requires the removal and reintroduction of the suspected allergen. The management includes a modification of the diet for nursing mothers and hydrolyzed formulas for babies with infant formula. The evaluation of the underlying immunopathology can influence the prognosis.
The allergy to cow’s milk proteins (APLV) affects more and more babies and is a serious problem because children can only ingest breast milk (with the mother on a dairy diet) or a select group of medicated milks that are very expensive.
According to the data that emerged from the 5th International Symposium on Food Allergies held in Argentina, the APLV affects 1 in 40 newborns and occurs mostly during the first year of life and then, with less frequency of appearance, it goes decreasing according to the age of the patients.
On average it takes a year to reach an accurate diagnosis of cow’s milk protein allergy and this delay can have an unfavorable impact on the child’s normal growth, with consequences such as low weight (1 in 5 children) or low size (14% of those affected).
The diagnosis of allergy to cow’s milk proteins is based on three fundamental pillars: the clinical evaluation and the analysis of the patient’s medical history; the immediate elimination of cow’s milk in his diet (exclusion diet) and the “food challenge”, which consists of administering to the child protein-rich foods of cow’s milk to confirm if an allergic reaction occurs or not.
In turn, doctors perform studies to detect IgE antibodies in blood that manifest the presence of allergy, a skin test and other allergy tests. The joint analysis of the patient and all these indicators allow the specialist to suspect and diagnose the presence of a CMA picture.
Milk Protein Allergy In Infants
The feeding of children with this allergy is very restricted because a large percentage of the products that we usually consume have milk protein as such, as a derivative, as an additive, in the form of traces or by contamination. This restriction is extended for mothers who breastfeed children with this problem and should also receive a calcium supplement. Experts agree that the exclusion diet is one of the main causes of the delay in the diagnosis of the condition.
Eating a product of these characteristics can generate in some children in addition to the delay in reversing their allergy, a variety of symptoms: vomiting, diarrhea, nausea, colic, regurgitation, blood and mucus in fecal material, rashes, hives and other symptoms less frequent as alimentary rejection, inconsolable crying, anaphylaxis, instability and failure of growth.
The Argentine Association of Allergy to Foods (Red Immunos) has been working with this problem for several years and was the driving force of a draft law on medicated milks that has a half sanction in Deputies and is awaiting treatment in the Chamber of Senators of the Nation.
The intake of hypoallergenic milks is divided into two types: formulas based on amino acids (AA), are synthetic free of milk protein and formulas based on extensive hydrolysates, containing modified protein components of cow’s milk protein with very low allergenicity, but not null.
Soy-based formulas and those of other mammals (goat, sheep, etc.) do not represent an alternative for the treatment of children with CMPA. In these types of milk cross-allergy can be present in up to 70% of cases.
It is fundamental for children who have APLV to consume the medicated milks, even beyond 2 years of life. “The fundamental reason why the coverage is requested, is because both the” 0 to 12 months “and the” more than 12 months “vary the can of 400 grams between the $ 300 to $ 1300 the most specific,” they explain from Red Immunos through a request for signatures made by the Change platform, which has the endorsement of more than 21 thousand people.
Keep in mind that on average a baby consumes about 10 cans per month, which represents the disbursement of 4 to 13 thousand pesos, according to the type of milk that the child should ingest.
Currently, social works are opposed in most cases to cover this costly treatment and “many families go to shelter resources or sell their belongings to feed their children to not get this benefit.”
If the law of medicated milk is implemented, the social works would be obliged to cover the costs of the milk or deliver it directly to the families.
From Red Immunos they assure that the allergy to the proteins of the milk of cow reverts in more than 95% of the cases and of is total, 80% is carried out before the 18 months and the remaining 20% before 4 or 5 years.
Milk Protein Allergy Treatment
If babies are fed exclusively or as a supplement to breastfeeding with either food, it is common for pediatricians to change the formula if the symptoms of intolerance.
There are a number of alternatives to formulas based on cow’s milk and include:
- Amino acid formula (AAF)
- Partially hydrolyzed formulation (pHF)
- Extended hydrolyzed formula (eHF), casein or whey
- Partial rice and / or eHF
- Soy formula
- Hydrolyzed soy formula
- Other mammalian milk (e.g., sheep’s milk, goat’s milk, camel’s milk); some adapted to the nutritional needs of babies, others do not
Milk formulations can be hydrolyzed to eliminate allergenic epitopes. pHF have been developed with the aim of minimizing the number of sensitizing epitopes within milk proteins, while at the same time remaining peptides obtained in size and immunogenicity sufficient to stimulate the induction of oral tolerance (and therefore are not suitable for the treatment). eHF has been extensively hydrolyzed to destroy allergenic epitopes; where most of the nitrogen is in the form of free amino acids and peptides <1500 kDa. The eHF are indicated in the treatment and prevention. The AAF formulas have been developed to overcome the hypersensitivity that may arise from the remaining proteins in eHF. AAF are only indicated in the treatment.
During EHF and AAF eliminate allergenicity, loss of immunogenicity in CMA prevention also prevents the immune system from developing tolerance to milk proteins. As a result, pHF is commonly used for the prevention of allergies. Since PHFs contain larger peptides in the CMA treatment such as EHF, they dissolve in a relatively high percentage and sensitized infants activation symptoms and, therefore, are not recommended if there is a risk of severe symptoms of CMA. AAF is> 95% of those who tolerated that they are allergic to cow’s milk and, therefore, are hypoallergenic, while pHF is tolerated in about 50-66% of individuals allergic to milk and, therefore, is not considered hypoallergenic. While pHF is not considered as “hypoallergenic”, according to these criteria, it is recognized that they have a reduced allergenicity and therefore have a place and are often used by doctors in the prevention of childhood allergy.
Decisions about when and how to change the formula may vary from one specialist to another. Therefore, there are a series of guidelines for the harmonization of diagnosis and treatment strategy. Rice hydrolysates are safe alternatives for eHF in the treatment of CMPA. Soy formula has been shown to be safe and effective in 85-90% of children with CMPA. Other mammalian milk is not indicated in the treatment of CMPA, since most of them are not suitable as food because they are not “baby foods”. In some countries, goat milk exists as a commercial baby food and is adapted to the nutritional needs of babies. However, the cross-reactivity with CMP is approximately 80%. As a result, the milk of other mammals can not be recommended in the treatment of CMPA.