Milk allergy: Clinical features and diagnosis
- Kirsi M Jarvinen-Seppo, MD, PhD
Kirsi M Jarvinen-Seppo, MD, PhD
- Associate Professor of Pediatrics and Medicine
- University of Rochester School of Medicine
Cow's milk allergy (CMA) is the most common food allergy in young children, but is uncommon in adults . This food allergy presents with a wide range of clinical syndromes due to immunologic responses to cow's milk proteins that can be immunoglobulin E (IgE) mediated and/or non-IgE mediated [2-4] CMA does not include other adverse reactions to milk, such as lactose intolerance, which are nonimmune mediated . (See "Lactose intolerance: Clinical manifestations, diagnosis, and management".)
The epidemiology, pathogenesis, clinical features, and diagnosis of CMA will be presented in this topic review. Cross-reactivity of cow's milk with other mammalian milks and management of milk allergy are discussed separately. General discussions of food allergy are presented separately in appropriate topic reviews. (See "Milk allergy: Management".)
General population — Cow's milk allergy (CMA) is the most common food allergy in young children, affecting approximately 2 percent of children under four years of age . CMA is even more prevalent in infants. Two studies published in the 1990s reported a CMA prevalence of 2.2 and 2.8 percent at one year of age in general population birth cohorts [6,7], consistent with the rate found in another cohort of over 6000 newborns followed for 18 to 34 months . In contrast, a lower rate of 0.6 percent in three-year-old children was reported .
The prevalence of CMA in adults is not as well reported . The rate of CMA by patient report in a multinational survey of 17,280 adults (aged 20 to 44 years) from 15 countries that questioned participants about foods that "nearly always" caused "illness" or "trouble" was 4.3 percent. However, a much lower proportion of adults have confirmed CMA, ranging from 0.1 to 0.3 percent [1,9,11,12]. Allergy persists from childhood in a subgroup of adults with CMA, but two reports suggest that the majority of adults with CMA acquired the allergy in adulthood [13,14].
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- General population
- Referral populations
- CLINICAL FEATURES
- Immunoglobulin E (IgE)-mediated reactions
- Mixed IgE- and non-IgE-mediated reactions
- - Atopic dermatitis (eczema)
- - Allergic eosinophilic gastrointestinal disorders
- Non-IgE-mediated reactions
- - Food protein-induced enterocolitis syndrome
- - Protein-induced proctitis/proctocolitis
- - Gastroesophageal reflux
- - Infantile colic
- - Constipation
- - Heiner syndrome
- NATURAL HISTORY
- IgE-mediated reactions
- - Asthma
- Non-IgE-mediated reactions
- Diagnostic pitfalls
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS