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Cow's Milk Protein Intolerance

From Mediwikis

Features

  • Onset when cow's milk is introduced into the child's diet
    • Can come through from the mothers diet, or from formula milk.
  • Transient, not true allergy
  • More common in atopic families (i.e. families with a history of allergies/asthma/hayfever/eczema)

Presenting Complaint

Sudden onset, after introduction of cow's milk. Symptoms include:

  • Vomiting
  • Diarrhoea (or constipation)
  • Abdominal pain
  • Skin rashes and urticaria
  • Headaches
  • Colitis
  • Wheezing

There may then be problems with weight faltering. In severe cases anaphylaxis can occur.

Investigations and Management

  • Bloods
    • ↑ WCC (white cell count) - differential shows ↑↑ Eosinophils
    • ↑ IgE
  • Can do antibody tests to specific proteins found in the diet, these are called RAST tests
    • The child will be +ve for cows milk protein intolerance
  • Biopsy
    • Taken if diagnosis is not clear and child has weight faltering
    • A sample of the jejunum is required to differentiate between cow's milk protein intolerance and Coeliac Disease

The only truly diagnostic test is to exclude the cow's milk from the child's diet, see if the symptoms resolve and then re-introduce cow's milk at a later date and see if the symptoms come back.

Management

To relieve symptoms the parents/carers must remove all cow's milk from the child's diet. This can be very difficult as even small amounts contained in other foods can cause a reaction. Refer to a dietician who specialises in paediatrics to ensure that the child can remove all cow's milk from their diet and still maintain a healthy intake.

Note Soy milk is not recommended in children as it contains large amounts of phyto-oestrogens

Prognosis

  • Most children grow out of this condition
    • Usually by around 2 years
    • A cow's milk trial can be performed around then to see whether they no longer experience symptoms. This is performed with the child in hospital in case a rare anaphylaxis occurs