Milk Protein Allergy
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Introduction
Incidence of 4% in the infant population
dlp: how would cow's milk get into the breast milk?
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Can occur in formula- or breast-fed
Infants have increased permeability of the gut, placing them more at risk. Infants can outgrow it.
premature infants not at increased risk
Pathophysiology
Slow-onset, non-IGe associated reaction.
Cow's milk protein is 80% casein (curds) and 20% whey.
There are over 25 potentially allergic proteins, including:
- bovine serum albumin
- beta lactglobulin
- alpha lactalbumin
- casein
- bovine immunoglobulin
- lactoferrin
Signs and Symptoms
- history
- physical exam
History
- irritability
- difficulty feeding
- vomiting
- diarrhea, with potential blood
- failure to thrive
milk does NOT cause increased mucous
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
- hypo-albumineima
- iron deficiency
Diagnostic Imaging
Differential Diagnosis
Treatments
A first step is to eliminate cow's link protein.
Breast-feeding is an important alternative.
Usual formulas to use include:
- casein hydrolyastes (hypoallergenic)
- elemental formula
- meat-based (home-made)
- soy protein
goat's milk
Consequences and Course
Resources and References
Topic Development
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