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Milk allergy

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 

Milk allergy is an adverse immune reaction to [principally] cow's milk.  It is a food allergy, but as we have received requests for more specific help on this problem, we have provided a separate entry.   

Cow's milk protein allergy (CMPA)

CMPA was first recognised in the 1930s, but has been growing in prevalence.  Milk allergy is an immunological reaction to one or more milk proteins:

  • α-lactalbumin
  • ß-lactoglobulin
  • casein.

For both cows' milk and goats' milk, around 80% of the protein present is casein based and around 20% is whey based.  It is thus important to know which protein in particular is causing the allergy.  The casein proteins found in milk can be divided into four major types: alpha, beta, gamma and kappa caseins.

There is a subtle difference in protein composition between the two milks with regards to the proportion of each type of casein they contain. Goats' milk contains more beta caseins than cows' milk, whereas cows' milk contains more alpha caseins, particularly alpha-s1-casein.

Thus unless one knows specifically which protein is involved it is unwise to consider goat’s milk safe, despite this often being called cow’s milk allergy.

 

The diagnosis of reproducible adverse reactions to cow's milk proteins (CMP), i.e. CMPA, still has to be confirmed by controlled elimination and challenge procedures.

Advanced diagnostic testing using epitope and microarray technology may in the future improve the diagnostic accuracy of CMPA by determination of specific IgE against specific allergen components of cow's milk protein. PMID: 24450456 [Indexed for MEDLINE]

In other words it is still difficult to know which specific protein is responsible.  It might be added that since this paper, metagenomic testing offers new hope for more accurate diagnosis.

In the United States, 90% of allergic responses to foods are caused by eight foods, with cow's milk being the most common. CMPA affects approximately 2-7.5% of children; and
persistence in adulthood is theoretically uncommon since a tolerance develops in 51% of cases within 2 years and 80% within 3-4 years. “[PMID: 20836734]

These findings are consistent with other research papers, for example:

 

A cohort of 1,749 newborns from the municipality of Odense, born during 1995 at the Odense University Hospital, were followed up prospectively for the development of cow's milk protein allergy/intolerance (CMPA/I) during the first year of life.

Once a diagnosis of CMPA/I was confirmed, a milk-free diet was continued until a new milk challenge had shown development of tolerance.

All infants with CMPA/I were rechallenged at 12 months of age and, in the event of continued clinical sensitivity to cow's milk protein, controlled rechallenges were performed every 6 months up to 3 years of age; and thereafter every 12 months until the age of 15 years. ………..

Based on controlled milk elimination and challenge procedures, the diagnosis of CMPA/I was confirmed in 39 out of 117 infants, with symptoms suggestive of CMPA/I, thus resulting in a 1-year incidence of CMPA/I of 2.2%.

The overall prognosis of CMPA/I was good, with a total recovery of 56% at 1 year, 77% at 2 years, 87% at 3 years, 92% at 5 and 10 years and 97% at 15 years of age. PMID: 12688620

CMPA/I may be IgE or non-IgE associated and responsible for immediate or late onset symptoms. The difference depends on the types of white blood cells involved. B cells, a subset of white blood cells, rapidly synthesize and secrete immunoglobulin E (IgE) a class of antibody which bind to antigens, i.e., the foreign proteins. Thus, immediate reactions are described as IgE-mediated. The delayed reactions involve non–IgE-mediated immune mechanisms initiated by B cells, T cells, and other white blood cells.

 

Lactose intolerance

Lactose intolerance is a condition in which people have symptoms due to the decreased ability to digest lactose, a sugar found in milk products.  Those affected vary in the amount of lactose they can tolerate before symptoms develop.

Although it is, indeed, a problem with ingesting milk, it is treated completely separately.  Lactose intolerance is a nonallergic food sensitivity, due to the lack of enzyme lactase in the small intestines to break lactose down into glucose and galactose.

The unabsorbed lactose reaches the large intestine, where resident bacteria use it for fuel, releasing hydrogen, carbon dioxide and methane gases. These gases are the cause of abdominal pain and other symptoms.

Symptoms

Most of the symptoms of milk allergy occur very early on

Symptoms suggestive of CMPA may be encountered in 5-15% of infants emphasizing the importance of controlled elimination/milk challenge procedures. Reproducible clinical reactions to CMP in human milk have been reported in 0.5% of breastfed infants. Most infants with CMPA develop symptoms before 1 month of age, often within 1 week after inter introduction of CMP-based formula. PMID: 24450456 [Indexed for MEDLINE]

When allergy symptoms occur, they may be rapid or gradual in onset.

 

Approximately 50-70% have cutaneous symptoms, 50-60% gastrointestinal symptoms and 20-30% respiratory symptoms. Symptoms may occur within 1 hour after milk intake (immediate reactions) or after 1 hour (late reactions). PMID: 24450456 [Indexed for MEDLINE]

Rapid symptoms may include anaphylaxis, a potentially life-threatening condition.  There are other symptoms that may develop:

In children younger than 10 years of age, 41% developed asthma and 31% rhinoconjunctivitis. Children with non-IgE-mediated CMPI had a good prognosis, whereas children with IgE-mediated CMPA in early childhood had a significantly increased risk for persistent CMPA, development of other food allergies, asthma and rhinoconjunctivitis.
During early infancy, recurrent wheezing was the most prevalent disease (20%), followed by atopic dermatitis (14%) and food allergy (7%) at 18 months of age. Physician diagnosed asthma increased from 2% at 1.5 years of age to 9% at 10 years of age. Rhinoconjunctivitis increased from <1% at 1.5 years of age to 9% at 10 years of age.
Overall, the current prevalence of any atopic disease was 20% at 1.5 years of age, declining to 14% at 5 years of age and followed by an increase to 25% at 10 years of age.
Sensitization to inhalant and/or food allergens (specific IgE of > or = class 2; CAP RAST) showed a low rate of sensitization among asymptomatics (3%, 10% and 12%) compared with higher rates of sensitization of 8%, 39% and 30% among symptomatic atopics at 1.5, 5 and 10 years of age respectively.
The highest rate of sensitization (53%) was found among children with current asthma at 10 years of age.  PMID: 12688620

 

 

Causes

Pharmaceuticals

In the food allergy section and in the section on Intestinal disease, we explain that many pharmaceuticals - particularly antibiotics, disrupt the intestinal flora.  We will not repeat the explanations here,  if you follow the link you will be able to find the full explanation with papers. 

Very briefly, if the intestinal flora is disrupted, the intestinal wall may be breached and food particles can then enter the blood stream.  Once there the immune system will recognise them as invaders and develop an immunological record of them as potential pathogens.  Thus a baby given antibiotics when very young, and fed on milk formula or even mother's milk, may develop a reaction to milk and it will happen very early on.

The same may be true if the mother is given antibiotics that disrupt her intestinal flora whilst she is pregnant, food may seep through into her bloodstream and she and her baby may end up with food allergies.

Caesarian or abnormal birthing practises

We now know that the intestinal flora of the baby is dependent on the birth process.  Many essential bacteria and other microbes are swallowed and become the seeds for the living garden in the baby's gut.  Any birthing process that results in the baby's flora being deficient, may then result in food particles leaking into the blood stream of the baby and thereby causing an immunologic record being made of the food being a pathogen. 

Despite being an apparently small and vulnerable little soul, a baby's immune system, once it has been kick started into action, is extremely efficient, principally because, if properly looked after, it has nothing to worry about - it is not stressed, and stress is the main inhibitor of an effective immune system. 

Thus a happy contented baby birthed 'abnormally'  may develop a violent reaction to any food that has leaked through.

The medical community is currently researching ways of helping the baby regain its flora, but they have already established that many commercial probiotics make it worse until the intestine has 'healed'.

Vaccines

We saw that CMPA is an immunological reaction to one or more milk proteins

  • α-lactalbumin
  • ß-lactoglobulin
  • casein.

So the question is then, why does the body develop an immunological reaction to these proteins – what are we doing to create this reaction?  And one of the principal answers appears to be that we are vaccinating against them.

A vaccine has three parts - excipient, adjuvant and the pathogen against which you wish the immune system to create a response.

When injected into the blood stream, the adjuvant tells the immune system to fight everything in the vaccine.  Both lactalbumin and casein are used in the manufacture of certain vaccines.  The body is following orders.

... Face it! the human body is doing EXACTLY what the vaccine tells it to do. The aluminum and other adjuvants intended to incite a hyper reaction to virus proteins are inciting hyperreaction to ALL the proteins because the immune system doesn't know to do anything more than recognize an amino acid sequence. Doesn't matter one whit if it is a string from Hep B virus or a string from soy peptones or casein-derived amino acids or corn derived dextrose or GMO yeast from the culture or oils or phenol red added for contrast. Adjuvants say "fight what we are showing you", and the immune system does...often in perpetuity.

 

This list of vaccine ingredients [extracted from the complete list on Wikipedia] indicates the culture media used in the production of common vaccines and the excipients they contain, as published by the United States Centers for Disease Control and Prevention and Food and Drug Administration.

Vaccine ingredients and production in other nations are substantially the same.

Also listed are substances used in the manufacturing process.  As you can see ß-lactoglobulin is not used but bovine [cow’s milk] casein and α-lactalbumin are.

 

 

Vaccine

Culture media

Excipients

DTaP (Infanrix)

Cohen-Wheeler or Stainer-Scholte media, Lathan medium derived from bovine casein, Linggoud-Fenton medium derived from bovine extract, synthetic or semisynthetic

Aluminum hydroxide, bovine extract, formaldehyde, glutaraldhyde, polysorbate 80

DTaP-IPV (KINRIX)

Vero (monkey kidney) cell culture, synthetic or semisynthetic

Aluminum hydroxide, calf serum, formaldehyde, glutaraldehyde, lactalbumin hydrolysate, neomycin sulfate, polymyxin B, polysorbate 80

DTaP-HepB-IPV (Pediarix)

Bovine protein, Lathan medium derived from bovine casein, Linggoud-Fenton medium derived from bovine extract, Vero (monkey kidney) cell culture, synthetic or semisynthetic

Aluminum hydroxide, aluminum phosphate, calf serum, lactalbumin hydrolysate, formaldehyde, glutaraldhyde, neomycin sulfate, polymyxin B, polysorbate 80, yeast protein

Tdap vaccine (Boostrix)

Fenton media with bovine casein, Lathan medium derived from bovine casein, Linggoud-Fenton medium derived from bovine extract, Stainer-Scholte liquid medium, synthetic or semisynthetic

Aluminum hydroxide, bovine extract, formaldehyde, glutaraldehyde, polysorbate 80

Typhoid vaccine (oral – Ty21a/Vivotif)

 

Amino acids, ascorbic acid, casein, dextrose, galactose, lactose, sucrose, yeast extract

 

 

But, there is an apparent argument against vaccines.  As we have seen above development of reactions to cow’s and goat’s milk occur very early, within a matter of months.  In a small number of cases the symptoms appear in breastfed infants

We thus need to look at the schedule of vaccinations to see if the vaccines for DTAP and Typhoid are given very early.  The question of breastfed infants then has to be addressed differently.

If one examines the schedule for vaccinations in the USA, the typhoid vaccine is not on the schedule, but the DTAP vaccine is.  This appears to indicate that the culprit might be the DTAP vaccine for all but the breastfed infants: 

USA vaccinations from Birth to 15 Months

Vaccine

Hepatitis B  (HepB)

Rotavirus (RV) RV1 (2-dose series); RV5 (3-dose series)

Diphtheria, tetanus, & acellular pertussis(DTaP: <7 yrs)

Haemophilus influenzae type b  (Hib)

Pneumococcal conjugate  (PCV13)

Inactivated poliovirus  IPV:<18 yrs)

Influenza(IIV)

Measles, mumps, rubella  (MMR)

Varicella (VAR)

Hepatitis A (HepA)

Meningococcal MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)

Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)

Human papillomavirus (HPV)

Meningococcal B

Pneumococcal polysaccharide(PPSV23)

 

 

Of these the schedule appears to indicate that ONLY the DTAP/Hep B is given in those first weeks. 

In other words, it is possible that the incidence of allergy is dependent on which vaccine you were given, although we could find no research as yet to support this hypothesis.

If we now examine the new UK schedule in contrast, to see if a pattern emerges we find the following:

 

Current UK immunisation schedule for 2018

The current UK vaccination schedule is shown below. It is the same for all areas of the UK.

AGE

Immunisation (Vaccine Given)

2 months

DTaP/IPV(polio)/Hib/HepB (diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b and hepatitis B) - 6-in-one injection (Infanrix hexa®); plus:
PCV (pneumococcal conjugate vaccine) - in a separate injection (Prevenar 13®).
Rotavirus (Rotarix®) - oral route (drops).
Meningitis B (Bexsero®).

3 months

DTaP/IPV(polio)/Hib/HepB -in-one injection, 2nd dose (Infanrix hexa®); plus:
Rotavirus (Rotarix®) - oral route (drops).

4 months

DTaP/IPV(polio)/Hib/HepB -in-one injection, 3rd dose (Infanrix hexa®); plus:
PCV 2nd dose (Prevenar 13®) - in a separate injection.
Meningitis B 2nd dose (Bexsero®).

Between 12 and 13 months

Hib/MenC (combined as one injection) - 4th dose of Hib and 1st dose of MenC (Menitorix®); plus:
MMR (measles, mumps and rubella) - combined as one injection (Priorix® or M-M-RVAXPRO®); plus:
PCV 3rd dose (Prevenar 13®) - in a separate injection.
Meningitis B 3rd dose (Bexsero®).

Adults

DTaP: for pregnant women from 20 weeks of gestation to protect the newborn baby against whooping cough (Boostrix®).

 Despite the presence of the DTAP vaccine in this list, it is not given until 2 months and the allergy or intolerance appears earlier.  But we do see one key finding in adults.  DTaP is given to the pregnant mother from 20 weeks of gestation, in other words the vaccination is being to both mother and child, and in this case may account for the problems of breastfeeding babies.  If they are given milk formula as well then a reaction may occur.

Please note that this is an hypothesisBut it is an hypothesis with scientific backing

Some researchers have observed that culture media used for commercial vaccine against Chlostridium tetani, Corynebacterium diphteriae and Bordetella pertussis could have been supplemented with aminoacids derived from the hydrolysis of milk proteins. Authors have demon-strated, with an ELISA essay, a concentration between 8.1 and 18.3 ng/mL of casein peptides in 8 different batches of DTP (Diphteria-tetanus-pertussis) vaccine .

Furthermore, hidden amounts of alpha-lactalbumin have been detected even in some oral polio vaccine (OPV) . Four children, receiving OPV and measles-mumps vaccine at the same time, have shown severe systemic reactions after vaccines injections. In these children there was a previous history of milk proteins allergy but no egg-allergy.

As well, skin prick test and serum specific IgE were positive for milk proteins but negative for egg proteins. Moreover, skin prick test with OPV, but not for measles-mumps vaccine, were positive.  Although based on these scattered case-studies, due to the possible presence of milk proteins in OPV and DPT vaccine, it has been suggested, in children with history of milk’s proteins anaphylaxis, a 60 minutes observation after vaccination PMCID: PMC4384976

Treatment

The suspicion of CMPA is based on detailed family and medical history, skin test, patch test, laboratory test, an elimination diet and food challenge.

The general treatment for CMPA is dietary: elimination of cow's milk protein and introduction of extensively hydrolyzed whey or casein formula, amino acid formula, and soy formula. Extensively hydrolyzed whey or casein formula is recommended as first choice for infants in mild or moderate reactions, amino acid formula in severe CMPA and in cases with poor response to extensively hydrolysed whey or casein formula.  PMID: 20836734

and

The basic treatment of CMPA is avoidance of CMP. In early childhood a milk substitute is needed. Documented extensively hydrolysed formulas are recommended, whereas partially hydrolysed formulas should not be used because of a high degree of antigenicity and allergenicity associated with adverse reactions. In case of intolerance to extensively hydrolysed formulas and multiple food allergies a formula based on aminoacids is recommended. Alternative milk substitutes such as sheep's and goat's milk should not be used because of a high degree of cross reactivity with CMP. Milk from other mammals such as mare and donkey may be tolerated by some children with CMPA. Soy protein is as allergenic as CMP and soy formula is not recommended for young children with CMPA because of a great risk of development of allergy to soy, whereas soymilk is normally tolerated in older children with CMPA. PMID: 24450456 [Indexed for MEDLINE]

 

References and further reading

  • Cow's milk allergy: where have we come from and where are we going? - Host A, Halken S.  Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital, DK-5000 Odense C, Denmark. arne.hoest@rsyd.dk.
  • Pediatr Allergy Immunol. 2002;13 Suppl 15:23-8.   Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood.  Høst A1, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K.  Department of Pediatrics, Odense University Hospital, Odense, Denmark. arne.hoest@ouh.fyns-amt.dk
  • El-Agamy EI 2007. The challenge of cow milk protein allergy. Small Ruminant Research.  68: 64-72
  • Int J Immunopathol Pharmacol. 2013 Apr-Jun;26(2):435-44. Detection of bovine alpha-S1-casein in term and preterm human colostrum with proteomic techniques. Orru S1, Di Nicola P, Giuliani F, Fabris C, Conti A, Coscia A, Bertino E.  CNR, Institute of Science of Food Production, Turin, Italy.
  • Clin Transl Med. 2015; 4: 3. Published online 2015 Feb 14. doi:  10.1186/s40169-014-0043-0PMCID: PMC4384976   Vaccination in children with allergy to non active vaccine components   Fabrizio Franceschini, Paolo Bottau, Silvia Caimmi, Giuseppe Crisafulli, Liotti Lucia, Diego Peroni, Francesca Saretta, Mario Vernich, Carlotta Povesi Dascola, and Carlo Caffarelli
  • Slater JE, Rabin RL, Martin D. Comments on cow’s milk allergy and diphtheria, tetanus, and pertussis vaccine. J Allergy Clin Immunol. 2011;128:434. doi: 10.1016/j.jaci.2011.06.028
  • Parisi CA, Smaldini PL, Gervasoni ME, Maspero GF, Docena GH. Hypersensitivity reactions to the Sabin vaccine in children with cow’s milk allergy. Clin Exp Allergy. 2013;43:249–54. doi: 10.1111/cea.12059

Report all clinically significant adverse events in the USA to the Vaccine Adverse Event Reporting System (VAERS) online or by telephone (800-822-7967).

NOTE:  For those who accuse the USA and 'big pharma' of being negligent in changing the ingredents of vaccines, it may be worth knowing that in 2010, India produced 60 percent of the world's vaccines, worth about $900 million(€670 million).

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