Is milk not for everyone?
The main task of the immune system is to recognize “self” and “foreign” cells. It reacts mainly to substances of protein nature, forming either a “Friend” (so-called immunological tolerance) or “Enemy” (antigen) response. When the response is “Enemy,” specific substances (antibodies) are produced that are aimed at fighting it. But, as with any system, there are failures.
Allergy (atopy) is an example of one such failure, when even friends are blacklisted. The child’s immune system begins to react to BCM inappropriately and excessively, blacklisting it. Beneficial protein turns into an allergen. This reaction is called "hypersensitivity."
The reasons for the occurrence of such “problems” are not reliably known to anyone. Scientists only build hypotheses, accumulate and systematize knowledge. All experts agree that genetic predisposition plays an important role. The only way to break the vicious circle of allergies and help a person is to exclude the causally significant allergen from the diet (environment) of this person.
This is called elimination (and elimination measures).
Milk allergens
Cow's milk contains more than twenty substances of different protein nature.
The most significant allergens are casein, alpha-lactalbumin, beta-lactoglobulin and milk lipoproteins. Casein and beta-lactoglobulin are found in the milk of other animals. Therefore, if you are allergic to cow's milk, you may be hypersensitive to the milk of other animals, such as goat's milk. If you are allergic to alpha-lactalbumin from cow's milk, a cross-allergy to beef proteins is possible.
Lipoproteins are less active allergens responsible for the occurrence of allergies to butter.
Some people have an isolated allergy to cheese. At the same time, a person tolerates whole milk perfectly. In this case, there is an allergy to molds that are used in cheese production, and not to milk proteins.
Allergy to dairy products occurs in children of the first year of life, preschoolers and school-age children.
In adults, milk allergy is rare, and poor tolerance to whole milk is associated with a lack of enzymes that break down milk sugar (lactose).
Atopic diseases. How to suspect them?
Often people don’t even know about the diagnoses listed above because they don’t see a doctor.
The following symptoms should alert you:
- seasonal nasal congestion or runny nose with copious mucus production
- occasional lacrimation
- bouts of coughing and sneezing
- prolonged dry cough
- bouts of difficulty breathing
- wheezing
- rashes, redness and itching of the skin
- skin prone to dryness and flaking (periods or after contact with something)
- redness and/or other skin reaction to sun or cold exposure
- skin irritation after contact with something
- reactions to insect bites
- reactions to drugs
If the above symptoms occur, then there is a high probability of atopy. In this case, it is better to seek advice from a specialist. If you have allergies, be sure to tell your pediatrician about it and monitor your child’s diet.
Is it possible to prevent the development of ABCM?
Yes.
During pregnancy, the process of “friend/foe” recognition begins. The future mother’s nutrition plays a significant role in this. Products containing choline, methionine, zinc, folic acid, vitamins B6 and B12 can regulate gene function and contribute to the formation of tolerance (body resistance) to CMP.
During breastfeeding, you can limit the consumption of dairy products and other obligate allergens. This will reduce the burden on the child’s body and will also contribute to the formation of an adequate response of the immune system to BCM.
Obligate allergens are foods that often cause allergic reactions: eggs, fish, seafood, legumes: peas, beans, soy, peanuts; nuts, honey, strawberries, pomegranate, kiwi, melon, black currant, mushrooms.
Useful to know about MILK ALLERGY (melk)
MILK ALLERGY
Useful information about milk allergies – Information sheet from the Norwegian Asthma and Allergy Association
What is a milk allergy?
With a cow's milk protein allergy, the body's immune system may react strongly by producing antibodies (IgE) or activating inflammatory cells. Every time you eat food containing milk proteins, an allergic reaction of the immune system is observed in the form of the production of mediators, such as histamine, or a T-cell inflammatory reaction. Histamine is produced in several places in the body and leads to symptoms such as diarrhea, nausea, abdominal pain or skin lesions (hives, eczema).
Cow's milk contains over 25 different proteins that can cause reactions in milk allergy sufferers. For most people, an allergic reaction can be caused by several types of proteins. The milk of other artiodactyls, such as goat, horse and buffalo, contains many of the same proteins. Therefore, allergy sufferers should not consume the milk of artiodactyl animals at all.
If a nursing mother herself consumes cow's milk, some proteins can be transferred along with mother's milk into the baby's body and lead to negative consequences. Therefore, a nursing mother should follow a dairy-free diet.
A cow's milk allergy is not the same as lactose intolerance. The latter occurs due to the body's reduced ability to digest milk sugar (lactose). Lactose intolerance leads to stomach pain and diarrhea as a consequence of consuming large amounts of dairy products with high levels of lactose (sweet milk, brown (goat) cheese, ice cream and cream).
Symptoms
Symptoms of dairy allergy vary greatly from person to person. For some, they are minor and harmless, but for others, a severe allergic reaction can occur, even when drinking a small amount of milk. Gastrointestinal upset is common. Not so often itching in the mouth and throat, swelling of the mucous membrane and breathing problems occur, which is especially typical for young children. It is also common for them to develop eczema and hives on the skin.
Who is affected?
Milk allergy is the most common type of allergy in young children, which is explained by the early inclusion of cow's milk in the diet of infants (for example, in cereals or in breast milk substitutes). About 2-5% of Norwegian children (0-3 years old) suffer from this type of allergy.
Diagnostics
In order to determine the presence of a milk allergy, the doctor must review the patient's medical history and also take a blood test for the presence of allergic antibodies and a Pirquet test. Not all milk allergy sufferers will test positive on these tests. This is especially true for infants with symptoms such as vomiting, diarrhea, or blood in the stool. The only reliable way to find out whether milk is causing these symptoms is to eliminate milk from the diet for a certain period of time. If in doubt, reintroduce it into the diet and see if symptoms return. For children who have not received milk for some time due to allergies, a control test using cow's milk should be carried out to ensure that there is no allergic reaction.
Forecasts
Usually, cow's milk allergy has a fairly good prognosis. Most children get rid of it before reaching school age. Infants who have had negative test results are often allowed to resume milk intake after six months or a year. It is unknown how many adults suffer from milk allergy, but it is estimated that the number is no more than one percent of the population.
Where is milk protein found?
Milk is found in many semi-finished and finished industrial food products. Therefore, when purchasing a product, it is important to familiarize yourself with the list of substances it contains. The goods declaration must indicate all ingredients containing milk. A certain group of words used in such lists indicates the milk protein content of the product:
Creme fraiche, cream, ice cream, casein, caseinate, feta cheese, lactalbumin, margarine, whey, whey powder, cheese, cheese powder, sour cream, butter, yogurt, yogurt powder.
Cocoa butter, lactic acids and substances of group E do not contain milk protein.
Diet
Milk is an important source of nutrients in the Norwegian diet. 25% of the protein children get, 70% of the iodine and about 70% of the calcium come from dairy products. That is why, in cases where dairy products are excluded from the diet, these products should be replaced with others that will ensure the intake of the above nutrients. As an alternative, specially formulated supplements can be used.
How to replace milk?
- Beverages:
For young children, a hypoallergenic milk replacer is recommended, which can be purchased at the pharmacy. These products can be purchased at a pharmacy or obtained with a “blue prescription” (preferential prescription). Because these milk replacers may be difficult to introduce to older children due to their taste, it is recommended that milk replacers be started as early as possible, such as while breastfeeding. Youth and adults can consume milk substitutes such as rice milk, oat milk, etc. The amount of calcium contained in these products corresponds to the calcium content in cow's milk, but these drinks often contain less protein and nutrients.
- Cooking food:
Milk substitutes purchased at the pharmacy can be used in most dishes. Depending on what you are preparing, you can use soy, rice or coconut milk.
– Other substitutes:
The following products are available in a dairy-free version - margarine, sour cream, yogurt, ice cream and cream substitutes based on soy, rice or oats.
If supplementary feeding is needed?
In the first three months, all children, regardless of the degree of risk of developing CM, are recommended to use only mixtures with specially prepared protein. Their degree of allergenicity is significantly reduced, which is why they are called hypoallergenic. The NutrilakPremium Hypoallergenic mixture is additionally enriched with probiotics and food substrate for their growth and development (prebiotics). The NutrilakPremium Hypoallergenic fat component in combination with lutein best provides all the needs for the development of the child’s brain, vision and motor skills.
How does an allergy to BCM manifest in a baby?
Symptoms of ABCM can be very different.
With skin lesions:
- the appearance of dry skin, sometimes in the form of plaques
- redness of certain areas of the skin (around the mouth, arms and legs, cheeks, chest and abdomen)
- the appearance of weeping spots and crusts with severe itching
- long lasting diaper rash
Involving the gastrointestinal tract:
- private regurgitation
- colic
- constipation
- diarrhea
- mucus in stool
- blood-streaked stool
- poor appetite and slow weight gain
The mucous membranes of the eyes, nose and respiratory tract may be involved with the following symptoms:
- lacrimation
- prolonged runny nose
- distant wheezes
- paroxysmal cough
All this can also affect the baby’s behavior in the form of:
- irritability
- sleep disorder
- bouts of crying and anxiety
It is important!
If symptoms persist after eliminating the causative allergen from the diet, it may not be a food allergy.
Contact your pediatrician immediately. In this case, a nursing woman needs to return to a balanced diet that includes all foods acceptable in the diet of nursing women (to prevent nutritional deficiencies in both her and the child).
If the baby is on mixed or artificial feeding, then together with the pediatrician it is necessary to decide on the correct selection of nutrition for him.
If the baby is already familiar with complementary feeding products, then together with the doctor, review the menu again. Make changes if necessary. Products containing BCM should be excluded. Keeping a food diary for mother and baby will greatly facilitate the process of finding the allergen and taking measures to eliminate it.
Milk is not prohibited
author: O. L. Eremina , nutritionist, AMC "Open Medicine", Togliatti, Samara region
author: N. M. Obidina , pediatrician, AMC "Open Medicine", Togliatti, Samara region
Tactics for introducing dairy products to children under one year of age with hypersensitivity to cow's milk protein.
“Cow's milk protein” is a collective concept that includes the names of many (about 40) protein molecules. The main ones with a high sensitizing potential:
- α-lactalbumin is a thermolabile protein, differs in species specificity, has cross-linking determinants with egg protein (ovalbumin);
- β-lactoglobulin makes up up to 10% of all cow's milk proteins, has the greatest allergenic activity, is species-specific, and thermostable;
- caseins - content in cow's milk is from 2.5 to 3.0%, especially a lot of casein is found in cottage cheese and cheeses; do not have species specificity, are thermostable, stable in the acidic environment of gastric juice, and precipitate during oxidation;
- Bovine serum albumin is found in cow's milk in trace amounts, but has a pronounced allergenic potential and is found in veal and beef.
Hypersensitivity to food
According to the classification of experts of the European Academy of Allergy and Clinical Immunology (EAACI), food hypersensitivity is realized through both immune and non-immune mechanisms.
IgE-mediated and non-IgE-mediated reactions are allergic types of hypersensitivity. They need confirmation or an educated guess. Here laboratory indicators and a thorough history taking are used. Elimination diet therapy acts as a therapeutic aid, and the introduction of causally significant foods into the diet acts as a diagnostic test.
Non-allergic hypersensitivity is provided mainly as a transient deficiency of enzymes, immaturity of the microbiome. This condition cannot be proven using laboratory tests. Here, the leading role in diagnosis is given to elimination diet therapy.
Why is it important to distinguish between these conditions?
In the case of non-allergic hypersensitivity, it is sufficient to gradually introduce dairy products after a fairly long elimination period. By this time, the child’s enzyme apparatus and microbiome will have matured, and all the prerequisites for the formation of tolerance to cow’s milk protein will have been formed.
In the case of allergic hypersensitivity, there are a lot of nuances (this is titration of the dose of the product, gradual and scrupulous formation of tolerance, close cooperation with allergists, etc.).
First dairy products
Stages of introducing dairy products specified in the national program for optimizing the feeding of children in the first year of life:
- Milk porridge - 4–6 months.
- Cottage cheese - no earlier than 6 months.
- Unadapted fermented milk drinks - no earlier than 8 months.
For non-allergic hypersensitivity
When breastfeeding, we administer a trial introduction of cow's milk protein to the nursing mother. This first occurs two months after the start of elimination. If symptoms return (albeit to a small extent), we continue elimination. In the future, such procedures are carried out once every 2–3 months. When symptoms do not persistently return when elimination therapy is discontinued, dairy products can be introduced.
When artificial feeding, two months after the administration of highly hydrolyzed formulas, in the case of a complete and persistent absence of hypersensitivity symptoms, you can introduce a mixture with partially hydrolyzed protein (hypoallergenic mixture, for example, Bellakt GA 1+, Bellakt GA 2+). The transition between mixtures usually takes three days. If symptoms do not return, it is recommended to introduce an adapted whole protein mixture no earlier than two months later. If well tolerated (if the timing has approached), you can begin to introduce fermented milk products (for example, Bellakt KM 1, 2).
The fermented milk drink is introduced first. Typically a dose of 100 ml is reached within five days. If there is complete tolerance, we begin to introduce cottage cheese: 50 g is introduced over 3 days.
For allergic hypersensitivity According to recent recommendations, if a diagnosis of cow's milk protein allergy is confirmed or reasonably suspected, the infant should remain on a dairy-free diet for at least 6 months and at least until 9–12 months of age. If breast milk is available, natural feeding is maintained, and the mother follows a diet excluding all products containing milk protein, as well as beef and veal.
When artificial feeding, a medicinal mixture based on highly hydrolyzed protein or amino acids is used to feed the child.
There is no such thing as an allergy to breast milk proteins!
The reaction can only occur to those extremely small amounts of foreign food proteins or histamine-releasing substances that pass into breast milk.
Diagnostic administration of the product The amount of the product containing cow's milk protein for the first test administration is determined based on the anamnesis data (the amount of the product to which the reaction was noted, the severity of the reaction to this amount). Start with a dose significantly less than the one that caused the reaction. The dose for the first test can range from a few drops to 5 ml. The product is given once in the morning for complete control of immediate and delayed reactions. The period of observation of the reaction after the diagnostic administration of the product also depends on the nature of previous reactions to this product and ranges from 2 hours for immediate-type reactions to 2 days for a history of delayed-type reactions.
If there is no reaction to the first injection, the dose is gradually increased, and by the end of the first week the child can receive up to 100 ml of a product containing cow's milk protein. When assessing the manifestations of allergies when introducing the product, manifestations of allergies must be taken into account both from the skin, gastrointestinal and respiratory.
Where to begin?
In what quantity and in which products to introduce milk protein is one of the most important issues at the stage of expanding the diet.
As a product containing cow's milk protein, the following can be used for trial administration:
- For breastfeeding mothers - kefir, yogurt. When a child reaches the age of complementary feeding - children's bio-kefir, yogurt.
- For a child being bottle-fed, fermented milk formulas (for example, Bellakt KM 1, 2); upon reaching the age of complementary feeding - baby biokefir and yogurt.
A few words about cottage cheese. In light of the introduction of complementary foods for allergies, this product is considered as a concentrate of cow's milk protein, casein in particular. Therefore, it is introduced at the very end, when there is confidence in the formed tolerance.
If a child cannot tolerate large doses of cow's milk protein but can tolerate small doses, many food allergy specialists recommend using tolerated amounts of milk or dairy products in the child's diet. The purpose of such recommendations is to attempt to naturally induce tolerance. Thus, if a child tolerates only 30 ml of milk or formula, the diagnosis of cow's milk protein allergy remains, but a gradual progressive increase in milk protein in the diet is recommended, starting with the minimum tolerated amounts established during the diagnostic introduction of the product.
Important!
Whole cow's milk is not used at the stage of expanding the diet; preference is given to fermented milk products, the protein of which is partially fermented during the process of fermented milk fermentation.
According to experts, it has been shown that many children with milk allergies can, over time, tolerate milk protein that has been subjected to high-temperature processing. Up to 75% of children with an allergy to cow's milk protein begin to tolerate boiled or otherwise heat-treated cow's milk with age, including in baked goods. Such studies open up new approaches to the management of children with allergies to cow's milk protein and provide the opportunity for a more personalized approach at the stage of expanding the diet, when milk can be introduced into the diet in larger or smaller quantities, in the form of a greater or lesser degree of hydrolyzed or heat-treated and /or fermented foods.
AN UNREASONABLE STRICT DIET REDUCES THE QUALITY OF LIFE AND RESULTS IN PHYSICAL DEVELOPMENT BACKGROUND
How to confirm the diagnosis of ABCM?
There are not many tests in a doctor's arsenal for this, and there are no gold standards. There is no analysis that can confirm the diagnosis with 100% certainty.
The immunological tests performed can be divided into:
- nonspecific, confirming the allergic nature of inflammation
- specific, indicating the degree of significance of the influence of a particular allergen
Difficulties in diagnosing ACM It is extremely rare that only one allergen (CAM) is the cause, the trigger that triggers inflammation
- Most often these are several allergens at once (polyvalent allergy)
- There is cross-reaction between different groups of products
- If the child is breastfed, immunological tests are difficult to interpret (due to the presence of maternal antibodies in his blood)
Ways to select nutrition for ABCM
It all depends on the severity of the allergic process, existing symptoms, the age of the child and the type of feeding.
Breastfed
It is enough to organize the mother's nutrition.
With mixed feeding
If supplementary feeding is necessary, experts recommend using a mixture with split protein hydrolyzate. Of these, you can consider the Nutrilak Premium Hypoallergenic mixture.
Compared to whole molecules of cow's milk proteins, the allergenicity of its split protein is reduced by 100,000 times. Nutrilak Premium Hypoallergenic is suitable for the prevention of allergies in children at risk and the treatment of mild skin manifestations.
What is a food allergy?
Food allergy (FA) is a pathological reaction caused by the intake of a food product, which is based on immune mechanisms. This means that some children's immune systems respond with hypersensitivity reactions to certain foods.
The maximum incidence of food allergies occurs in the first year of life. Often, the first symptoms of food allergy appear already in a child’s first three months of life (up to 25%) with the introduction of formulas based on cow’s milk protein (CMP). The second peak in the frequency of detection of food allergies in infants occurs at 6–9 months of life (up to 20%).
It is important!
Nutrilak Premium Hypoallergenic contains lactobacilli L.rhamnosus LGG® - this is the most effective and safe probiotic for children from birth, used for the treatment and prevention of atopic dermatitis and eczema.
With artificial feeding
If the baby has pronounced skin manifestations, there are crusts and areas with weeping, or there is persistent heavy regurgitation, streaks of blood in the stool, then only deep hydrolysates (for example, Nutrilak PEPTIDE MCT) or amino acid mixtures can be used from mixtures.
Children over 6 months have a wider choice of food: there is more possibility of using complementary foods and soy mixtures (for example, NutrilakPremium Soya).
Is it possible to outgrow ABCM?
No!
If tolerance has not been formed and hypersensitivity to CMP remains, then the allergic inflammatory process occurs in the background. It may not be as pronounced, but it continues! Gradually, the foundation is laid for the development of chronic pathological diseases, turning into a time bomb.
What else is useful to know?
In the process of forming a reaction to an allergen, not only the response of the immune system is important, but also the background against which it unfolds.
It is known that products such as chocolate, cheese, citrus fruits, vinegar, nuts, marinades, etc. are a source of special substances (histamine liberators). They help maintain allergic inflammation by adding fuel to this fire. Limiting their intake or completely eliminating them will reduce the manifestations of atopy and help alleviate the child’s condition.
The smallest friends are microorganisms. Most of them live in the large intestine. They are our great helpers. Their contribution to curbing allergic reactions and forming the correct response to food is difficult to overestimate. More and more studies are confirming this. And if your own intestinal inhabitants can’t cope with this, then trusted friends – probiotics – can come to the rescue. All over the world, only two microorganisms have the largest evidence base on the antiallergic effect - LGG and BB-12 from Chr. Hansen. One of them even has its own website (https://www.lgg.com/).
Allergy to milk?
Allergy to milk?
Allergic diseases are common throughout the world today. For example, about 20-30% of Russians suffer from lactase deficiency - intolerance to milk sugar (lactose). We talked about the causes, symptoms and methods of treating lactase deficiency with Elena Markovna BULATOVA, professor, doctor of medical sciences, vice-president of the St. Petersburg branch of the Union of Pediatricians of Russia.
— Elena Markovna, explain what lactase deficiency is?
- Milk sugar - lactose - is the main carbohydrate in both breast and cow's milk. Lactose in its chemical structure consists of glucose and galactose. The breakdown of lactose into glucose and galactose occurs in the small intestine under the action of a special enzyme - lactase. If for some reason the production of the lactase enzyme in the body is disrupted, lactase deficiency develops.
— Is this disease hereditary?
— Research shows that primary lactase deficiency is caused precisely by a hereditary deficiency of the lactase enzyme, the so-called hypolactasia.
If both parents have hypolactasia, it will be passed on to all children in the family. If a deficiency of the lactase enzyme is detected in the mother or only the father, then it is not necessary that this disease will overtake the child.
— Can deficiency of the enzyme lactase appear with age?
— People with a hereditary predisposition are more at risk than others for lactase deficiency, especially if they have inflammatory bowel diseases.
Also, secondary lactase deficiency often develops with infectious, allergic and autoimmune lesions of the intestine. In addition, milk intolerance occurs with short bowel syndrome or after a long period of parenteral nutrition (a method of delivering nutrients through a vein).
— What other forms of allergies overlap with lactase deficiency?
— Infants and young children may be allergic to cow's milk protein. The frequency of this type of allergy in children ranges from 2 to 7%. Therefore, when diagnosing lactase deficiency, it is necessary to conduct an examination to exclude an allergy to cow's milk protein.
— What are the features of diagnosing lactase deficiency?
— From laboratory examinations, it is very important to make a coprogram with determination of stool pH.
A widespread and effective method abroad is the determination of hydrogen in a person’s exhaled air, which increases with lactase deficiency.
The gold standard for diagnosing congenital lactase deficiency is the study of lactase activity in small intestinal biopsies.
It is very important to know that a patient with lactase deficiency should be observed, in addition to a pediatrician or therapist, also by a gastroenterologist and an allergist-immunologist.
— How does a milk allergy manifest itself?
— Everything is very individual. Clinical manifestations of lactase deficiency may be: increased gas formation in the intestines (flatulence, intestinal colic, regurgitation in infants); frequent, loose, yellow, foamy, sour-smelling stools after drinking milk or other dairy products containing lactose. In this case, the patient’s appetite may be good. But symptoms of dehydration (dehydration), insufficient weight gain, and changes in intestinal microflora are also possible.
— Breast milk also contains lactose. So, if a newborn is found to have a deficiency of the enzyme lactase, will he have to stop breastfeeding?
- Not necessary. On the contrary, if a child has lactase deficiency, a decrease in the amount of human milk is undesirable. In order for the baby’s stomach to better absorb breast milk, enzyme preparations “Lactase Baby” and “Lactazar” are used, which are mixed with expressed breast milk (20-30 ml). The baby first drinks expressed fermented milk, after which it is breastfed.
— Should a nursing mother follow a diet?
— A woman who feeds her baby with breast milk must exclude highly allergenic foods from her diet: fish, seafood, eggs, mushrooms, nuts, honey, coffee, chocolate, cocoa, and also (!) whole cow’s milk.
— In what cases is a baby transferred to lactose-free formulas?
— Ineffectiveness of treatment with enzyme preparations can occur in cases of severe lactase deficiency in a child. Then replace from 1/3 to 2/3 of the volume of each feeding with a lactose-free mixture. Moreover, they first give the baby a lactose-free formula, then supplement it with breast milk.
The lactose-free mixture is introduced into the child’s diet gradually, bringing it to the required amount over 3-5 days. Improved digestion is judged by a decrease in flatulence, the nature of the stool and other indicators.
When artificial feeding, it is also advisable to first use enzyme preparations for treatment; if they are ineffective, the standard milk formula is gradually replaced with a lactose-free one.
It should be noted that the first complementary feeding product for children with lactase deficiency should be dairy-free porridge (rice, corn, buckwheat) or porridge diluted with lactose-free formula or lactose-free milk.
— What can an adult replace regular milk with if there are problems with its digestibility?
— First of all, it is necessary to determine what minimum volume of milk a person can consume without developing dyspeptic disorders. Large doses of milk can also be absorbed if the amount is distributed correctly throughout the day. In this case, intestinal bacteria adapt to lactose. It is also advisable to use both prebiotics and probiotics in treatment to improve intestinal microflora.
If even the smallest amounts of lactose cause unpleasant symptoms in a person, regular milk is excluded from the menu and replaced with lactose-free milk. For example, lactose-free milk with 1.5% fat content from Valio Eila has recently appeared in Russia, which in taste does not differ from regular milk and retains all its beneficial properties.
Ekaterina Koroleva.
