For Healthcare Professionals only

Anaphylaxis A Major Food Allergy Condition in Infants
By - Danone Nutricia Academy

This myth buster brings to you the key facts about cow’s milk allergy (CMA) which will help to identify and manage the symptoms effectively.

Key takeaways-

  • CMA can be a threat.
  • Symptoms of food allergy can appear over a range of time.
  • Food allergy can affect infants with eczema, and not all food allergies diminish as the infant gets older.

1. Myth: CMA is not a fatal form of allergy

Fact: Cow’s milk is the most common food allergen in infants. Infants with IgE (Immunoglobulin E)-mediated food allergy can develop severe anaphylaxis. Food-induced anaphylaxis is the most severe and life-threatening reaction, with the highest occurrence rate in 0–4 years of age. Food allergy can impact multiple organ systems, including the skin, respiratory tract, and gastrointestinal system.1

2. Myth or reality: Cow's milk intolerance causes majority of symptoms

Fact: According to the World Health Organization (WHO) and the European Academy for Allergy and Clinical Immunology (EAACI), CMA is associated with the immune system. Symptoms induced by cow's milk in infants are caused by an allergic reaction to the milk proteins mainly, casein- α1-, α2-, β-, and κ-casein and whey- α-lactalbumin and β-lactoglobulin, known as IgE-or Non-IgE-mediated allergy. It differs from lactose intolerance, which develops due to insufficient lactose (milk sugar) digestion, causing diarrhea, bloating, and colic distress.2,3

3. Myth or reality: CMA always manifests themselves shortly after drinking cow’s milk

Fact: Fact: CMA likely occurs in the first few months of birth, with a prevalence of 1.5 to 3% in India. Diarrhea, emesis, and even life-threatening anaphylaxis are all possible symptoms. CMA responses are classified as either rapid onset-generally IgE mediated with symptoms appearing within minutes-two hours of consumption or slow onset-non-IgE mediated with symptoms appearing with one hour- several days later.4,5

4. Myth or reality: Infants with eczema do not suffer from food allergies like CMA

Fact: The most prevalent antigens implicated in IgE-mediated allergy are cow's milk and egg. During the first year of life, the incidence of IgE-mediated CMA is greater in infants with severe eczema. 7

5. Myth or reality: All food allergies in infants diminish as they get older

Fact: Some infants may be able to tolerate foods that they were previously allergic to as they get older. In the case of milk and egg allergies, this is more likely to occur. Population-based studies show that by the age of one year, >50% of infants develop a tolerance to cow's milk. Peanut and tree nut remission rates, on the other hand, are substantially lower.2,8

Conclusion

During an infant's first years of life, CMA can lead to the fatal condition- anaphylaxis. Food allergies, mainly CMA mediated by IgE (Immunoglobulin E) in infants can cause severe, life-threatening anaphylaxis. In such infants, a prompt diagnosis and appropriate intervention are vital. An effective treatment involves the infant's diet being totally devoid of cow's milk proteins.

References:

  1. Sackesen C, Altintas DU, Bingol A, Bingol G, Buyuktiryaki B, Demir E, Kansu A, Kuloglu Z, Tamay Z, Sekerel BE. Current trends in tolerance induction in cow's milk allergy: from passive to proactive strategies. Frontiers in pediatrics. 2019 Sep 18;7:372.
  2. Cow's Milk Allergy: myth v reality. [Internet] [2020] Available at: https://www.nutricia.co.uk/hcp/
    resource-centre/cows-milk-allergy-myth-v-reality.html. Accessed on: 31/05/2021
  3. Lifschitz C, Szajewska H. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. European journal of pediatrics. 2015 Feb;174(2):141-50.
  4. Edwards CW, Younus MA. Cow Milk Allergy. [Internet] [21 Nov, 2020] Available at: https://www.ncbi.nlm.nih.gov /books/NBK542243/#:~:text= Typically%20the%20presence%20 of%20cow's, emesis%20to%20life% 2D threatening%20anaphylaxis. Accessed on: 31/05/2021
  5. Matthai J, Sathiasekharan M, Poddar U, Sibal A, Srivastava A, Waikar Y, Malik R, Ray G, Geetha S, Yachha SK. Guidelines on Diagnosis and Management of Cow’s Milk Protein Allergy. Indian Pediatrics. 2020 Aug;57(8):723-9.
  6. Czerwionka-Szaflarska M, Łoś-Rycharska E, Gawryjołek J. Allergic enteritis in children. Przeglad gastroenterologiczny. 2017;12(1):1.
  7. Kawada S, Futamura M, Hashimoto H, Ono M, Akita N, Sekimizu M, Hattori H, Goto M, Horibe K, Maeda N. Association between sites and severity of eczema and the onset of cow’s milk and egg allergy in children. Plos one. 2020 Oct 19;15(10):e0240980.
  8. Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P. Cow's milk protein allergy in children: a practical guide. Italian journal of pediatrics. 2010 Dec;36(1):1-7.

IMPORTANT NOTICE: MOTHER’S MILK IS BEST FOR YOUR BABY

The World Health Organization (WHO)* has recommended that pregnant women and new mothers be informed of the benefi¬ts and superiority of breast-feeding, in particular, the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for and maintenance of lactation, with special emphasis on the importance of the well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle feeding or other foods and drinks should be discouraged since it will have a negative effect on breast-feeding. Similarly, mothers should be warned of the diffi¬culty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and ¬financial implications of her decision. For example, if a baby is exclusively bottle-fed, more than one can (500g) per week will be needed, so the family circumstances and cost should be kept in mind. Mother should be reminded that breast milk is not only the best but also the most economical food for babies. If a decision to use infant formula is taken, it is important to give instruction on correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect dilution can lead to illness.

*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.

Importance of Breastfeeding:

(i) Immediately after delivery, breast milk is yellowish and sticky. This milk is called colostrum, which is secreted during the fi¬rst week of delivery. Colostrum is more nutritious than mature milk because it contains more protein, more anti-infective properties which are of great importance for the infant's defense against dangerous neonatal infections. It also contains higher levels of, Vitamin 'A', (ii) breast miIk- A) is, a complete and balanced food and provides all the nutrients needed by the infant [for the ¬first six months of life] (B) has anti-infective properties that protect the infants from infection in the early months (C) is always available; (D) needs no utensils or water (which might, carry germs) or fuel for its preparation, (iii) breastfeeding is much cheaper than feeding infant milk substitutes as the cost of the extra food needed by the mother is negligible compared to the cost of feeding infant milk substitutes, (iv) mothers who breast-feed usually have longer periods of infertility after child birth than non-lactators; (b) details of management of breast feeding, as under:- (i) breast-feeding- (A) immediately after delivery enables the contraction of the womb and helps the mother to regain her ¬figure quickly; (B) is successful when the infant suckles frequently and the mother wanting to breast-feed is confi¬dent in her ability to do so (ii) in order to promote and support breast-feeding the mother’s natural desire to breast feed should always be encouraged by giving, where needed, practical advice and making sure that she has the support of her relatives. (iii) adequate care for the breast and nipples should be taken during pregnancy. (iv) it is also necessary to put the infant to the breast as soon as possible after delivery, (v) let the mother and the infant stay together after the delivery, the mother and her infant should be allowed to stay together (in hospital, this is called "rooming-in"); (vi) give the infant colostrum as it is rich in many nutrients and anti-infective factors protecting the infants from infections during the few days of its birth; (vii) the practice of discarding colostrum and giving sugar water, honey water, butter or other concoctions instead of colostrum should be very strongly discouraged; (viii) let the infants suckle on demand; (ix) every effort should be made to breast-feed the infants whenever they cry; (x) mother should keep her body and clothes and that of the infant always neat and clean. Breast-feeding is the best form of nutrition for babies and provides many benefi¬ts to babies and mothers. It is important that, in preparation for and during breast-feeding, you eat a healthy, balanced diet. Combined breast and bottle-feeding in the ¬first weeks of life may reduce the supply of your own breast-milk and reversing the decision not to breast-feed is dif¬ficult. Always consult your Healthcare Professional for advice about feeding your baby. The social and fi¬nancial implications of using infant formula should be considered. Improper use of an infant formula or inappropriate foods or feeding methods may present a health hazard. If you use infant formula, you should follow manufacturer's instructions for use carefully - failure to follow the instructions may make your baby ill.

IMPORTANT NOTICE

Breast milk is best for babies. At Danone, we support breast feeding and believe that breast milk is the best food for babies as the sole source of nutrition for the first 6 months of life and is recommended to be continued until 2 years with the introduction of appropriate complementary foods after 6 months of age.

IMPORTANT NOTICE: Breastfeeding is the best for babies and a healthy diet / maternal nutrition is important when breastfeeding. A decision not to breastfeed can be difficult to reverse. Infant formula is suitable from birth when babies are not breastfed. It is recommended that all formula milks be used on the advice of a doctor, midwife, health visitor, public health nurse, dietitian, pharmacist, or other professional responsible for maternal and child-care and the financial implications should be considered. All preparation and feeding instructions should be followed carefully as inappropriate preparation could lead to health hazards. this is the same as the above – does this need to be included

For the use of healthcare professionals only, not for distribution to general public.

Published by: Nutricia International Pvt. Ltd. Building A, unit no. 304, 3rd Floor, Agastya Corporate Park, Kamani Junction, L.B.S. Marg, Opp. Fire Brigade, Kurla (West), Mumbai 400070

CVM code: 1610086372523

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