Cow's Milk Allergy (CBC) is an abnormal response of the body's immune system to milk and dairy products containing cow's milk proteins. ISA is the most common type of food allergy, but in most of these cases, cross-allergy to goat, sheep, and even soy can also be seen.
After milk protein enters the body, the reaction often occurs within minutes or hours. Symptoms and signs of ISA can range from mild to severe. For example, a 2-month-old baby with a very severe cow's milk allergy may consult a doctor with severe vomiting, diarrhea or eczema when he/she is exclusively breastfed, while a baby with a mild allergy may manifest himself with a slight flushing when he first eats yoghurt at 6-7 months of age.
Milk allergy in children. Although symptoms are most common in infants under 6 months of age, the first symptoms may occur even after the age of 2.
CLINICAL FINDINGS
Mild Severity Moderate SevereLife-Threatening Severe
Digestive System Symptoms 25-50%
Skin Symptoms 50-60%
Respiratory Symptoms 25%- 30
Note: If skin and digestive system symptoms occur together, the possibility of ISA is much higher.
Source: Prof. Dr. Fügen Çokuğraş. Cow Milk Allergies presentation. Pediatric Gastroenterology Congress, October 2012.
Symptoms in ISA
It is also possible to classify according to the time of appearance of symptoms in ISA:
EMERGENCY WARNING
• Extreme paleness and laxity
• Chima on the tongue, lips and neck
• Bloody diarrhea
According to estimates, 1 in every 20 children has ISA, but To diagnose ISA, it is necessary to eliminate other diseases that may cause the current symptoms. For example, it is necessary to perform a stool test to distinguish whether bloody diarrhea is caused by ISA or amoebic dysentery. Another example can be given for a 2-3 month old baby with severe vomiting: Severe vomiting may also occur in pyloric stenosis, severe reflux, and cow's milk allergy. e… ISA should not be diagnosed and treated without distinguishing them.
In some people, it is very easy to detect food allergies, especially ISA, because as soon as the patient touches his lips to that food (for example, yoghurt), his face turns red, becomes hot, and burns. ; swollen lips, watery eyes, runny nose... Rarely, severe allergic reactions such as shortness of breath and feeling of suffocation may occur, requiring an urgent call for an ambulance at 112. (Thankfully, I have not encountered such severe conditions called anaphylaxis; this condition is extremely rare in children, but occurs more frequently in adolescents and adults.)
Sometimes the symptoms of ISA are vague and difficult to detect. Especially if there is a "delayed hypersensitivity" mechanism and not IgE-mediated, a relationship between food and symptoms cannot be established and the child will inevitably continue to consume that food. It causes chronic symptoms such as eczema, reflux, colic, developmental grayness, and diarrhea/constipation in infants. These symptoms quickly regress when the culprit food (our topic here is milk protein) is removed from the diet.
JESUS and Eczema
You can also read about eczema in detail here. Here we will try to explain more the relationship between ISA and eczema.
Babies with eczema under 3 months of age most likely have food allergies, most commonly ISA. The earlier the symptoms appear, the more severe the disease. There is discomfort on the skin due to dryness, flaking, and itching. While babies who cannot localize the itching area experience restlessness and crying, as the age progresses, the baby begins to localize the itching area and becomes able to scratch the lesion. In this case, a vicious cycle of scratching-irritation-drying-increased itching begins. The aim of treatment is to prevent this vicious circle and to identify the allergen as soon as possible and remove it from the baby's life. In ICA, symptoms begin to improve rapidly when cow's milk protein is removed from the diet.
ISA and Eosinophilic (Allergic) Digestive System Diseases
Eosinophil is a type of leukocyte (white blood cell) whose number increases in allergic diseases. Normally, they are present in the blood circulation at a rate of at most 5% of total leukocytes. Wherever allergic disease occurs, eosinophils also concentrate there and play a role in inflammation. rlar.
Eosinophilic diseases have been defined depending on the involvement of different parts of the digestive system. If stomach involvement is predominant, the condition due to food allergy is called eosinophilic gastritis. Let's list a few names of allergic digestive system diseases below:
Eosinophilic esophagitis: It is the name of the disease that predominantly affects the esophagus.
Eosinophilic gastritis: It is the name of the disease that affects the stomach.
Eosinophilic enteritis: It is an allergic disease that predominantly affects the small intestines.
Eosinophilic gastroenteritis: Eosinophilic enteritis: It is an allergic disease that affects both the small intestine and the stomach.
Eosinophilic colitis: It is an allergic mucosa disease of the large intestine.
Eosinophilic proctocolitis: It is an allergic disease of the large intestine and rectum (straight intestine). p>
These conditions can be caused by foods other than cow's milk, but the most common main factor is cow's milk protein allergy.
For the curious
These diseases are also graded by pathological examination. In other words, it has 4 degrees, from mild to severe.
In the mildest case, there is mucosal damage on the inner surface of the intestine. In the second degree, there is damage to the submucosal tissues and an accumulation of Eosinophil cells.
In the third degree, there is a condition that passes under the mucosa of the intestines and penetrates the intestinal muscles.
The most severe form, 4 . In advanced disease, the outer membrane of the intestine is now damaged, and serum begins to leak into the abdominal cavity between the damaged intestines.
Eosinophilic Esophagitis (EoE)
Esophagus means esophagus. The esophagus is also affected in Eosinophilic Esophagitis. It is rarer than eosinophilic gastritis or eosinophilic enterocolitis. Although it is seen in less than 1/1000 of children, its frequency in society is increasing for unknown reasons. In addition to food allergy, allergic rhinitis and asthma are also observed in 50% of children with EoE.
What are the Symptoms of Allergic Esophagitis?
Difficulty in swallowing is the main symptom. This feeling, which can be better expressed by older children, is experienced by the patient as "the bite is in the esophagus". It is defined as "hanging out somewhere". In younger children, due to pain during feeding, they refuse to feed, cry during meals, and often vomit after feeding. It is extremely difficult to differentiate EoE from reflux because the symptoms are almost the same. Moreover, both EoE and reflux respond positively to antireflux treatment given on a trial basis. The main difference between eosinophilic esophagitis and reflux is that while reflux eases over time and is relieved by feeding in an upright position, EoE will continue as long as the allergen is detected and a diet is not made.
Eosinophilic Gastritis and Vomiting
In cases where allergic reactions occur mostly in the stomach, the main The symptom is vomiting. After consuming food containing cow's milk protein, cramp-like abdominal pain and protruding vomiting occur. Since there is no blood in the stool in these cases, it is extremely difficult to differentiate it from reflux and colic. In these patients, there is an increase in eosinophils in the blood and accumulation of eosinophil cells on the stomach wall. It is difficult to diagnose unless the mucus is removed.
In this disease, there is a picture characterized by the accumulation of allergy cells called Eosinophils in the walls of the intestines, bleeding in the intestinal mucosa, inflammation with increased mucus and edema, and an increase in eosinophils in the blood. The most common cause of eosinophilic enterocolitis is cow's milk protein allergy. In addition, soy, fish, egg, hazelnut, walnut and wheat proteins can also cause the same situation; In fact, both ISA and other food allergies can be seen in the same baby, causing the condition to be both more severe and more complex. In fact, the occurrence of enterocolitis due to allergens transmitted through breast milk in babies fed only with breast milk is a condition that is not as rare as it is thought and is increasingly common.
What happens in eosinophilic enterocolitis?
The main symptom is that the stool is watery and mucusy. . There is bleeding in the stool that is obvious or can be detected by analysis. Lesions usually involve the large intestine. Severe Eosinophil cell accumulation is observed in the inner membrane of the intestine (of course, if a biopsy is performed). If a colonoscopy is performed, small aphthous-like ulcers, edema, redness and bleeding lesions are detected. (The most precise The diagnostic method is colonoscopic biopsy, but it is not applied in practice)
Some stool tests that can be done are as follows: Microscopic examination of the stool: Red blood cells should be seen; The stool should be positive for occult blood; Although it is not possible to do this in practice, Eosinophil cells can be detected in the stool in some laboratories. The stool may be positive for reducing substance.
Skin tests are useless because IgE does not increase.
A response to the oral provocation test may occur within a few minutes to hours with vomiting, abdominal pain or, rarely, a severe allergic reaction. .
With the elimination of the allergen (here again cow's milk protein), blood in the stool disappears in approximately 72 hours, while full recovery of mucosal lesions takes up to 1 month.
Read: 0
