Milk allergy is a food allergy, involving adverse immune reaction to one or more of the constituents of milk from any animal, most commonly alpha S1-casein (i.e. protein in cow's milk).

• It is a food allergy, an adverse immune reaction to a food protein that is normally harmless to the nonallergic patient
• The major allergens in cow milk are alpha-s1-, alpha-s2-, beta- and k-casein, and the whey proteins a and b-lactoglobulin
• The body may raise an antibody-based immunoresponse, or a cell-based immune response to tehse allergens

• Hives
• Swelling
• Vomiting
• Wheezing
• Sx 1st arise in skin, then GI tract, and less commonly, the respiratory tract
• Rapid in onset, evolving within minutes or seconds, due to antibody-mediated allergy
• Always arise within 1 hour of drinking milk, but can occasionally be delayed longer when eating food contianing milk as an ingredient
• It can take several hours, or even up to 3 days to produce a clinical effect, if it is non-antibody mediated allergy, as it is delayed
• Can involve anaphylaxis, which is potentially life-threatening

• Elimination diet
• Skin prick tests
• Blood tests, to measure IgE, although even if negative doesn't rule out cell-based allergy
• Conducting in-office food challenges, with the double-blind placebo-controlled food challenge, still the gold standard for Dx for all food allergies, including milk allergies. It is particularly important to rule out food-based allergy

• Avoiding dairy products
• Because these proteins can be found in breast milk, nursing mothers should also abstain from dairy products prior to weaning
• Because proteins in various mammals are often cross-reactive, other forms of milk should not be substituted
• Milk substitute formulas, are use to provide a complete source of nutrition for infants. These include:
  • Amino acid formulas (aka elemental formulas), which are nondairy-derived, free amino acid-based formulas, are considered the gold standard in the Tx of cow's milk allergy, when the mother is unable to breastfeed
  • Soy-based formulas, although milk substitutes from soys, nuts and the like shouldn't be considered in babies, as they aren't nutritionally equivalent
  • Hypoallergenic formulas based on partially or extensively hydrolyzed protein formulas
• Elimination diet should be tested every 6 months by testing milk-containing products low on the milk ladder, like fully cooked foods contaiing milk, in which the milk proteins have been denatured, and ending with fresh cheese and milk
• Prednisone, will be prescribed to prevent a possible latent phase type 1 hypersensitivity reaction
• For accidental ingestion of milk products, drugs, including:
  • Epinephrine pen
  • Antihistamine, e.g. diphenhydramine, in case of accidental ingestion

• Affected infants lose clinical reactivity to milk during early childhood, or at latest by adolescence
• Around 50% of cases resolve within the 1st year, and 85% resolve within 5 years
• It is associated with increased hospitalization, and steroid use in kids with asthma
• 13-20% of kids allergic to milk, are also allergic to beef

• Anaphylaxis, a severe life threatening allergic reaction, but it is rare

• Most common food allergy in early childhood
• Affects between 2-3% of infants in developed countries
• Incidence in only breastfed infants is lower, at about 0.5%
• The epidemiology figures are in the antibody-based allergy, the allergy based on cellular immunity is uncertain

• Lactose intolerance, a NONallergic food sensitivity, and comes from a lack of production of the enzyme lactase, required to digest the predominant sugar in milk. It is considered a normal state for most adults worldwide, and not typically considered to be a disease