By Dr Bhaswati Acharya
The subject of food allergies is not new, but awareness about it has been dismal. As a result, misconceptions and inadequate information abounds. So, it is important to throw the spotlight on what is allergy and subsequently cow’s milk protein allergy (CMPA). A food allergy, in the strictest definition, is defined as our body’s adverse reaction to certain items we have consumed. There are food allergens present which are almost proteins but the point to be remembered is that not all food proteins can be classified as ‘allergens’. These allergens in turn create an immediate response where the immune system battles it, a process called an allergy. Now the food allergies can be caused by several food items in our diet like nuts, eggs, milk, etc, so it is of importance to know which food item is behind the allergy.
A major shift is seen now in the way allergies are developing, with some manifesting as early as infancy. Also, earlier this trend was limited to the developed countries but now it is spreading across the globe. During infancy a child is fed with mother’s milk and gradually complementary feeding is introduced. So, when a child is fed cow’s milk, he or she may develop an allergy towards it. The symptoms usually manifest within the first year of life. In India, cows’ milk is brought in as a regular milk in an infant’s diet as early as four months of age.
Another common misconception that is prevailing is that the bulk of households consume buffalo milk instead of cow’s milk. It will be helpful to bear in mind that protein, which is a major constituent of milk, is present both in cow’s and buffalo milk so if a child develops cow’s milk protein allergy, the odds of him developing an allergy towards buffalo milk is high. The good news is that cow’s milk protein allergy will not stay lifelong with children with most of them outgrowing this allergy by three years of age.
How to identify cow’s milk protein allergy
There are a plethora of symptoms linked squarely to cow’s milk protein allergy although the intensity will differ in infants. There is a common thread binding these allergies with maximum infants dealing with digestive and respiratory symptoms. Digestive symptoms can range from vomiting, frequent regurgitation, colic, diarrhoea, etc, while respiratory symptoms include wheezing and a runny nose. There are attendant skin symptoms too like hives, dry and itchy skin or swelling of lips. If your baby develops these symptoms, please consult your paediatrician immediately.
It is an uphill task to diagnose the CMPA as the symptoms bear resemblance to other conditions like lactose intolerance. For example, in lactose intolerance, our body is unable to digest a carbohydrate, lactose, because of a lack of the enzyme lactase. Its symptoms are diarrhoea, bloating and sometimes pain in the abdomen, which is erringly similar to CMPA. A prognosis by a medical practitioner is required to diagnose which of the two conditions it may be.
Certain tests can help to diagnose the CMPA. For example, a detailed medical and food intake history analysis is done to dismiss other conditions and zero in on cow’s milk protein allergy. There are also certain skin prick tests and patch tests available which are used but there is an inherent drawback that they are not able to detect all sorts of food allergies. The best available method is elimination followed by a challenge. There is complete elimination of cow’s milk from the diet to see if there is any improvement in the symptoms in 2-6 weeks, followed by a reintroduction of cow’s milk again. If the symptoms reappear, it confirms the CMPA.
So, when the prognosis is that an infant has CMPA, he/she should be kept on an elimination diet using extensively hydrolysed formulas or amino acid formulas for a period of six months followed by a reexamination to see if the infant has developed an acceptance for it. Parents should be advised on the repercussions of CMPA on the health of an infant since it occurs during the window of First 1000 days, which is crucial for the long-term growth and development of the baby.
(The writer is a paediatric surgeon, Amri Hospital, Kolkata.)
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