Milk Allergy

"Milk allergy" is an erroneous but often used designation in the population for one of the following diagnoses:


 * Allergy on cow milk protein;
 * Lactose intolerance

Allergy/Hypersensitivity on cow milk protein

 * an immunological response to any of the cows' milk proteins;
 * in addition to IgE-mediated reactions, other types of allergic reactions are involved;
 * it usually occurs in infancy;


 * manifests itself in gastrointestinal (approximately 60% of affected), cutaneous (50-60%) and respiratory symptoms (approximately 1/3), these symptoms are often combined;
 * gastrointestinal symptoms: zvomiting, diarrhea, malabsorption, gastroesophageal reflux, enterorrhea, constipation;
 * cutaneous manifestations: oral allergic syndrome, rash, urticaria, angioedema, eczema;
 * respiratory manifestations: runny nose, expiratory dyspnoea, cough;
 * anaphylactic reaction: drop in blood pressure, shock;
 * behavioral disorders: irritability, abdominal colic;
 * it's unlikely to take place if the baby tolerates full portions of cow's milk for more than 3 months;
 * diagnostics: elimination-exposure test - elimination of cow's milk from the diet and subsequent re-exposure to confirm the allergic nature of the reaction;
 * in the case of eosinophilic and non-IgE reactions, elimination must last at least 2 weeks, in the case of atopic dermatitis and allergic colitis 4 weeks;
 * skin prick tests and determination of the level of specific IgE against cow's milk have low sensitivity and specificity, they do not show a non-IgE reaction, they can also be false positive;
 * treatment: complete elimination of cow's milk from nutrition (extensively hydrolyzed formulas, possibly mixtures of amino acids), in breastfed children it is necessary to eliminate cow's milk proteins from the mother's diet and at the same time supplementation (mother) with calcium (1 g / day);


 * prognosis: cow's milk tolerance is gradually improving.

Lactose intolerance/malabsorption

 * impaired ability to break down lactose ('milk sugar');
 * lactose is a disaccharide that is broken down in the small intestine by lactase to glucose and galactose, and these are absorbed into the blood;
 * lactase is one of the brush border enzymes of enterocytes; a distinction is made between primary (congenital) lactase deficiency and secondary deficiency accompanying severe intestinal mucosal damage; undigested lactose travels to the large intestine, where it is fermented by bacteria to form hydrogen, methane, carbon dioxide, lactate and short-chain fatty acids;
 * the result is malabsorption and osmotic diarrhea;
 * manifests itself in abdominal pain, flatulence, diarrhea, nausea and vomiting;
 * diagnosis: anamnesis, stool examination (pH <5, reducing substance> 0.5%), positive hydrogen breath test after oral administration of lactose, disappearance of symptoms after exclusion of lactose from the diet;
 * treatment: lactose-free diet, preparations with lactase can be added to dairy products, with limited intake of dairy products it is necessary to supplement calcium.

Secondary lactose intolerance/malabsorption

 * reduced ability to tolerate the disaccharide lactose ("milk sugar");
 * may occur temporarily after acute diarrheal disease - the decrease in intestinal lactase activity is proportional to the degree of damage to the intestinal mucosa;
 * accompanies diseases associated with atrophy of the villi of the small intestinal mucosa, such as:


 * in differential diagnosis it is always necessary to exclude celiac disease by serological examination;
 * lactose intolerance is indicated by the presence of more than 0.5% reducing carbohydrates in the faeces and a faecal pH lower than 5.0;
 * treatment: temporary exclusion of lactose from the diet.

Congenital (primary) deficit of lactose

 * very rare
 * manifests itself in diarrhea from the moment the baby is given milk, including breast milk;
 * the stool is watery, foamy and acidic;
 * identification: molecular-genetic examination;
 * treatment: dietary measures - lactose-free milk, preparations containing lactase.

Lactose malabsorption with late lactose deficit -adult hypolactasy

 * autosomal recessively inherited; corresponds to the physiological process of declining enzyme activity that begins after weaning and manifests itself at any time from childhood to adulthood;
 * diagnostics: molecular-genetic examination, or intestinal biopsy;

Transient lactase deficiency in premature infants

 * in premature infants, relatively low lactase activity persists until the 36th gestational week.

Following articles

 * Intolerance jídla • Potravinová alergie