How Do You Determine If Your Child Has Cow's Milk Allergy/Food Sensitivity?
by Ronald Lanfranchi, D.C., Patricia Deuster, Ph.d.
& Russell Jaffe, M.D., PhD.

How do you determine if your child has COW'S MILK ALLERGY/FOOD SENSITIVITY? (CMA/FS) The most common tests used for diagnosing CMA/FS are the intracutaneious progressive dilution food test and the IgE RAST test. Both tests are intended to detect Ig-E- mediated, or immediate hypersensitivity reactions, and both have subapical positive predictive accuracy. Although the skin test method can be used for diagnosing late responders, it is rarely used to do so, and as such the only in vitro test currently used for diagnosing the delayed variety of food allergies is the ELISA/ACT test. This test appears to be reliable and highly specific, unlike the Bryant cytotoxic test, a test, that was essentially nonreproducible. The ELISA/ACT the uses a lymphocyte mixed cell culture to detect all hidden or delayed sensitivity ("delayed allergy") responses. These included types, 11, 111, and IV responses, or cytotoxic, complex-mediated, and cell-mediated, immune reactions, respectively; it does not test for immediate hypersensitivities. Another way to diagnose CMA an FS is by an elimination diet. Elimination diets involve removing one or more suspected foods from the diet for at least three weeks. Ideally, only whole foods, organic or biodynamically grown, should be eaten during he period of elimination so the food(s) being eliminated is not a hidden ingredient. In this way, if the symptom(s) disappears and relief is striking, the food being avoided may be considered the offender. After the period of elimination, the offending food(s) should be reintroduced in sizable amounts to challenge the individual, but this is rarely done; only one food should be reintroduced at a time. Alternatively, if no relief is obtained from avoiding a particular food, and no improvement in the symptoms is achieved, the specific food can be returned to the diet. It must be realized that dietary elimination is very time consuming, and patient subjectivity may bias the results. Moreover, unless you are very careful, it is often difficult to avoid offending foods.

If an elimination diet identifies specific foods to which the child is reactive, then complete avoidance of the food for a period of time is desirable. Yet, complete and prolonged abstinence is not always possible, even with the most highly motivated parents and children. The gastrointestinal (GI) tract is a major barrier to foreign antigen entry, and infants with CMA commonly demonstrate GI symptoms. In other cases, the intestines are the source of foreign invaders without other symptoms associated with the GI tract. Repeated exposure to cow's milk has been shown to make the intestine more permeable to other food proteins by activating local immune responses in the intestinal mucosal cells. When the function of the mucosal barrier is compromised by exposure to milk antigens, enhanced absorption of other potentially antigenic food remnants can lead to the development of multiple food allergies. In fact, it is very common for children with CMA to develop adverse reactions to other foods as they get older. For example, an infant may present with an allergy to cow's milk and then become sensitive to eggs, citrus, fish, wheat, soy and/or other foods. Avoiding cow's milk does not guarantee freedom from other food allergies, but maintaining the integrity of the intestinal tract should reduce antigen exposure and its subsequent entry into the circulation.

Although CMA and FS are serious concerns, children without CMA may also suffer when fed cow's milk products during their first year of life. Recent studies wherein nutrient intakes of breast-fed, formula-fed, and cow's milk- fed infants during the first 12 months were compared showed that milk-fed infants received unnecessarily high intakes of protein and electrolytes, sodium and phosphorous, and low intakes of readily bioavailable iron and the essential fatty acid, linoleic acid. High intakes of protein and electrolytes place an excessive load on the kidneys, and may lead to dehydration more rapidly when water intake is reduced or water loss is elevated, as in the case with fever, diarrhea, vomiting and high outside temperatures.

Another reason to avoid the introduction of cow's milk during the first year is that iron status may be compromised, even in the absence of CMA. Numerous studies have shown that cow's milk feeding during the first year of life may result in blood loss from the GI tract and increase the incidence of iron deficiency anemia. Since it is well established that iron deficiency in infants and toddlers can cause deficits in cognitive and psychomotor development, this could pose a serious problem to sensitive children. Moreover, the deficits may not be correctable with iron therapy. Thus, many good reasons not to introduce cow's milk during the first year of life can be offered.

The seriousness of these potential health consequences justifies an attempt to manage, prevent, and/or treat the problem. Luckily, CMA/FS can be quite easy to manage when the mother is breast-feeding the infant, merely eliminate the offending foods from the mother's diet and avoid introducing those particular foods to the infant for at least the first year or two of life. It may sound strange for the mother to avoid dairy products, eggs, corn and wheat, since most people believe that food proteins are completely digested in the stomach and intestines prior to absorption and, therefore, should not appear in breast milk. Many investigators have demonstrated the presence of the cow's milk proteins, B-lactoglobin, casein, and IgG, the egg protein, ovalbumin, and wheat proteins, gluten and gliadin, in breast milk. Abstention from these foods for a week results in a decline in breast milk levels of these proteins. Thus, avoidance of offending foods by the nursing mother is an effective approach for breast-fed infants. For formula fed infants, the use of non-dairy containing formulas is necessary. When the time to introduce solid foods arrives, it is wise to continue avoiding cow's milk products and other potentially offending foods until after the child reaches one year of age. Even after one year, such foods may continue to be offending, especially if any type of processed foods are provided. However, by one year the infant's gastrointestinal tract has had an opportunity to mature, with greater digestive competence, reduced permeability and the predisposition to FS usually lessens. Nonetheless, when reactive foods are finally introduced, care must be taken to be mindful of any immediate or delay-in-onset reactions.

How do you achieve a diet that is cow's milk-free or wheat-free? A milk-free diet means doing without milk, butter (although clarified butter, being antigen free, is permitted), cheese, ice-cream, yogurt, margarine and other products that contain casein, sodium or calcium caseinate, dried milk solids, and/or whey.  Although wheat products are extremely difficult to avoid if a whole foods diet is not consumed, it can be done, especially with the availability of such grains as amaranth, tritacle, spelt, teff, and quinoa.  Numerous processed foods contain some wheat and dairy products, and as such it becomes necessary to become an avid label reader-being sure to look for "milk and wheat words"! Similar rules apply to corn, soy, and eggs. Needless to say, some people find it difficult to be completely successful, but with a little assistance from trained nutritionist, and guidance from resources such as cookbooks, handouts and the availability of alternative food products, it is really not such a difficult task.

One concern expressed by many people on a dairy-free diet is "How do I obtain adequate amounts of calcium?" Dr. Frank Oski, a noted pediatrician at Johns Hopkins University, stated in his book Don't Drink Your Milk that "the majority of the world's population takes in less than half the calcium we are told we need and yet, by and large, has strong bones and healthy teeth." Thus, calcium intake doesn't need to be a problem for either the mother or infant. Many foods contain more calcium on a per calorie basis than milk products anyway. Further, these other sources of calcium are often lower in phosphate and sulfate, organic acids who excretion in the urine is balanced by minerals like calcium. Organic acids carry minerals like calcium along with them to balance or buffer the urine so that it does not become too acid. Thus, eating foods with a low organic acid content serve to spare calcium. many foods are rich in calcium. Cruciferous vegetables, such as broccoli, cabbage, Swiss chard, kale, spinach, collards and zucchini, provide more than 2.0 mg of calcium per calorie. For comparison, the average content of dairy products (milk, cheddar, cottage and Swiss cheese, and yogurt) is approximately 1.8 mg per calorie. When these vegetables are cooked blended, or used in juicing, the availability of calcium is high, as is the availability of many other essential nutrients. Vegetable juices and broths, particularly from organic or biodynamically grown foods, are high recommended. Ground sesame seeds and blackstrap molasses are also excellent sources of calcium. However, a calcium and magnesium supplement may be in order for moms if dietary intake of these calcium-rich foods is low.

Overall, the evidence is quite convincing that children and infants under one year of age should not be given dairy products in any form. It is reasonable to avoid wheat, eggs, and certainly any processed foods. If your child has CMA or you suspect other FS, you should have your physician perform appropriate diagnostic tests. The health and well-being of your child may depend on avoidance of offending foods. Furthermore, if your child has persistent colic, "flu symptoms", unexplained pain, failure to thrive, ear infections, asthma, skin problems such as eczema or psoriasis, consider CMA/FS as possible cause. An advanced cell culture technique, known as ELISA/ACT, is now available for testing so that if you suspect food allergies, you can determine exactly what foods or chemicals are reactive.

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PAC WEBSITE LINKS

Allergy to Casein and Whey by Theresa Willingham

Food Alternatives Alternatives to wheat, dairy, corn, etc.  Information about hidden products.