Cow's milk allergy is an immunological reaction to one or more of the cow's milk proteins. It is the most common food allergy seen in babies and young children. It is usually seen in children under the age of 3, and its frequency decreases with age, regressing by 80% after the age of 3. There are 20 allergenic proteins in cow's milk, and the most allergenic and responsible one is b-lactoglobulin.
In babies who are exclusively breastfed, milk protein passes to the baby through breast milk. Therefore, the gold standard in treatment is the elimination of cow's milk from the diet. Clinical findings are very variable. Usually, findings from more than one system are observed. The most common skin symptoms are 50-60% (rash, redness, itching, crusting behind the ear, persistent diaper rash and host formation, atopic dermatitis exacerbation), digestive system findings are 50-60% (vomiting, colic-like crying spells, constipation, diarrhea, stool loss). Green mucus appearance, punctate bleeding), It is observed in 20-30% of the respiratory system (shortness of breath, wheezing, bronchospasm, rhinoconjunctivitis). It may not be expected that all findings will be seen at the same time.
A family history of allergy and bronchial asthma is a serious risk factor. In diagnosis. The diagnosis is often suspected by taking a detailed history and careful physical examination.
In diagnosis, 1: laboratory tests, 2: elimination from the diet, 3: challenge tests are performed.
Among laboratory tests, allergy tests (cow's milk sp.IGE, IGE, SKIN PRICK TEST AND PATCH test) are examined. Tests show sensitivity to cow's milk. Negative tests do not rule out allergy.
If cow's milk is stopped, vomiting and eczema symptoms will disappear within 3-5 days, rectal bleeding and defecation symptoms will disappear within 1-2 weeks, and chronic diarrhea will disappear within 1-2 weeks. The signs and symptoms of growth and development retardation begin to improve within 2-4 weeks.
The food overload test is performed by giving the allergy-causing food orally and in very small amounts, after the baby's complaints and symptoms have passed. The overload test is performed under the supervision of a doctor. It should be done in a clinic or hospital environment.
If a baby with cow's milk allergy is receiving breast milk during treatment, breastfeeding should continue and milk and dairy products should be removed from the mother's diet. Considering the possibility of multiple food allergies, eggs, peanuts, hazelnuts and walnuts should also be restricted. The medications used by the baby should be checked, and probiotics and antiallergic drugs should be started if necessary. It would be appropriate to give the mother a daily calcium supplement of 1000mg/day. If there are severe clinical findings (enterocolitis, anemia, hypoalbunaemia), amino acid-based formula (neocate or pregomim AS) should be given for 2 weeks, and then breast milk + diet advice should be given to the mother. If the mother is not breastfeeding, it is necessary to use hydrolyzed or amino acid-based formula.
Tolerance development should be monitored intermittently. If there are mild clinical findings mediated by non-IGE, repeat trials should be made at 3-month intervals.
As a result, the diagnosis of cow's milk allergy should be made accurately and carefully during infancy, and the quality of life of the baby and the family should be improved as soon as possible.
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