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Milk Protein Allergy & Encopresis

Milk Protein Allergy

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What you should know...

Allergy to cow's milk is a well-studied form of food allergy. There are both immediate and delayed patterns of milk allergy. Immediate type allergy tends to be obvious and shows up on skin tests. Delayed patterns of milk allergy are not obvious, do not produce positive skin tests and tend to cause chronic disease that is seldom diagnosed. Cow's milk contains many proteins that are antigenic - they excite immune responses. Patients of all ages with gastrointestinal tract disease may have difficulty digesting these proteins and may absorb them as antigens. Milk problems may be attributed to lactose intolerance and the milk-sugar enzyme, lactase, may be prescribed. Milk allergy is a protein problem and is not improved by changing the milk sugar - often the diagnosis of "lactose intolerance" is incomplete or wrong and symptoms persist with only lactose exclusion.

Casein should not be confused with lactose. Most people who have difficulty digesting milk are lactose intolerant, meaning that they produce too little of the enzyme (lactase) that breaks down milk sugar (lactose) so bacteria flourish in their gut to finish the job. Lactose intolerance is no laughing matter, but it is not life threatening. A casein allergy can be just that-- an allergy. Allergies can be life-threatening, and should be taken very seriously. It may manifest as breathing difficulty, hives and rashes, or serious pain in the gut leading to inability to get nourishment from food and dangerous weight loss. You may not experience any of these symptoms, but you may experience chronic & severe constipation.

Infants who react to breastmilk are usually reacting to cow's milk protein in their mother's diet, protein which migrates from the mother's gut to her breastmilk.
 
Although many babies become tolerant of cow's milk protein before their first birthdays, some children can take a full year or longer, and some never become tolerant.
 
In children that become severely constipated due to milk protein allergy, by the time an allergy is realized, the child may or may not have outgrown the allergy, and may or may not develop the condition known as Encopresis. In children who have developed encopresis due to Milk Protein Allergy, and have outgrown the allergy, a cure can be a devestatingly difficult battle. Children with Milk Protein Allergy that do still have the allergy, in most cases, can make the neccessary dietary changes, and go on to lead happy, symptom-free lives.
 
To help prevent chronic constipation due to Milk Protein Allergy early on [which can lead to encopresis], if your breastfed baby is colicky, it is worth a try to eliminate cow's milk from your diet. You will want to avoid cheese, ice cream, milk (in a glass or on cereal), yogurt, puddings, custards, cream sauces, and butter. This is not a quick fix, however. Cow's milk protein can remain in breast milk for up to two weeks after the mother has stopped eating dairy foods. To see whether dropping dairy really makes a difference for your child, have your dietary experiment last about 3 weeks. If the change in your eating habits does improve your baby's colic, you will probably want to avoid dairy at least until the typical colicky period is over -- when your baby is 12 to 16 weeks old. If your child's colic was severe and it turns out that he or she is especially sensitive to cow's milk protein, you may want to avoid dairy even longer, and/or indefinitely to be sure [if] the child has outgrown the allergy. 

Infant milk allergy is thought to be a specific and limited condition which children "outgrow." This idea can be misleading because many children continue to have chronic symptoms from milk, although the original problem may disappear, the pattern of illness changes and confuses parents and physicians. At the very least, we can say that some children have an allergic diathesis that persists and evolves with different manifestations. Milk allergy is common in adults but is seldom diagnosed.

In a follow-up study of children with immediate anaphylactic reactions to cows milk as infants, a prolonged pattern of hypersensitivity was noted with the development of multiple food and inhalant allergies, multiple hospitalizations and frequent episodes of drug reactions. These children may continue to manifest hypersensitivity and grow into adults with immune-mediated diseases. Although there are few studies which focus on milk-induced disease in adults, there is enough suggestive evidence to suspect that milk proteins play a major role in human disease at all ages.

There are at least 30 antigenic primary proteins in milk. Casein is the most commonly used milk protein in the food industry; lactalbumin, lactoglobulin, bovine albumin, and gamma globulin are other protein groups within the milk. Digestion probably increases the number of possible antigens to over 100. Milk proteins are listed in food products with a variety of names such as milk solids, skim milk powder, casein, caseinates, whey and albumin. Milk proteins tend to stay intact as milk is converted to dairy products of all types. While lactose intolerance may not be an issue with yogurt ingestion, for example, milk protein allergy remains. Many patients have been fooled by health claims for lactose-free or lactaid-fixed milk and continue to have symptoms from milk allergy when they ingest these products. Digested fractions of each of the milk proteins may induce the production of IgE, IgA, and IgG antibodies and may trigger complex, variable immune responses. Skin tests with whole milk proteins are, therefore, misleading - type 1 responses do appear regularly on skin tests showing IgE activity against intact proteins, but secondary antigens are not detected.

Furthermore, milk antigens tend to get through the GIT mucosa intact and are therefore responsible for a host of delayed immune responses which do not depend on IgE and do not show up on skin tests. The role of milk proteins in triggering the most serious pathology usually goes undetected. Evidence of a pathogenic role of cows milk in many disorders has been presented - asthma, rhinitis, eczema, urticaria, serous otitis media, pulmonary alveolitis (hemosiderosis), milk-induced enteropathy in infants, eosinophilic gastroenteritis, gastrointestinal bleeding with iron deficiency anemia, migraine headaches, attention deficit hyperactivity disorder, Crohn's disease, rheumatoid arthritis, insulin dependent diabetes mellitus, and severe, chronic constipation.

The classic symptoms of milk intolerance are diarrhea, spitting up, or abdominal pain. Many kids with milk intolerance also wheeze, especially when they get a cold. They can also have the dry, sensitive skin of eczema and their noses always seem to be running. Ear infections are also more common than in other kids. Constipation, however, has not been typically associated with milk intolerance -- until now.

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This site does not replace the need for specific advice from your doctor. This site is for informational purposes only.