Milk allergy is an abnormal allergic response to proteins found in milk and dairy products. While it typically develops against cow's milk, it is also associated with other animal milks, such as goat's milk and buffalo milk. This allergic reaction is particularly common in breastfeeding infants.

A milk allergy occurs when the immune system reacts strongly to various proteins found in milk. While consuming milk normally doesn't cause any reactions, people with a milk allergy may experience symptoms such as skin rashes, diarrhea, bloating, and respiratory distress.

Milk allergy usually becomes apparent in newborns within the first six months of life and typically resolves spontaneously by school age. The allergy is often noticed after the baby is introduced to cow's milk or formula containing cow's milk. Cow's milk allergy is the most common type of food allergy. Therefore, when babies are first introduced to milk and dairy products, they should be monitored for signs of a possible allergic reaction.

Symptoms of milk allergy in babies

Milk allergy symptoms in babies typically occur in the gastrointestinal tract, skin, and respiratory system. If you suspect your baby has a milk allergy, you may want to look out for the following symptoms:

Gastrointestinal symptoms:

• Swellings in the mouth
• Difficulty swallowing
• Nausea and vomiting
• Milk flowing back from the stomach to the mouth
• Dyspepsia (upset stomach)
• Early satiety
• Refusing milk
• Diarrhea
• Loss of development
• Stomach ache
• Colic attacks
• Persistent constipation

Skin symptoms:

• Skin rashes
• Tingling and itching sensation around the mouth and lips
• Red spots in the mouth and throat
• dry cough
• Urticaria (hives)
• Angioedema (edema formation under the skin)

Respiratory symptoms:

• Difficulty breathing, wheezing
• Respiratory difficulties
• Runny nose and nasal congestion
• Symptoms similar to those of an infection in the eyes (redness, itching, watering)

If your baby exhibits one or more of the symptoms above, it's important to consult a qualified healthcare professional. Allergic reactions to proteins in cow's milk may be the cause of these symptoms. Your doctor will evaluate your baby's health and, if necessary, recommend diagnostic tests, such as allergy testing, to ensure a correct diagnosis.

Causes of milk allergy and protein groups

Cow's milk allergy results from a reaction to the proteins found in milk. The proteins found in milk can cause major or minor allergic reactions when ingested. The two main protein groups most commonly thought to cause these allergic reactions are caseins and whey proteins.

• Caseins: Caseins, which make up approximately four-fifths of all proteins in cow's milk, are the components that give milk its color. Caseins have a suspended structure and do not easily pass through the intestinal membrane. These proteins are introduced to the immune system via Peyer's patches and can trigger an immune response in the body, leading to allergic reactions. Casein proteins are more allergenic than whey proteins.
• Whey proteins: Whey proteins do not impart color to milk and are a highly soluble protein group. Whey proteins can easily pass through the intestinal membrane and may also cause allergic reactions.

Contrary to popular belief, pasteurization of milk may not inactivate these proteins and may continue to have allergenic effects.

Milk allergy is a type of allergy that can occur not only in infants but also in adults. Symptoms of a milk allergy in adults can include a runny nose, hives and itching on the skin, abdominal pain, gas, diarrhea, and vomiting. These symptoms may indicate an allergy to milk or dairy products.

Types and classifications of milk allergy

Milk allergies are classified according to the mechanism of the allergy. These classifications are based on whether the reaction is mediated by IgE and are as follows:

 IgE-mediated milk allergy:

• In IgE-mediated allergies, the immune response develops very quickly and symptoms appear immediately.
• Severe and fatal conditions may occur.
• Major symptoms occur rapidly and usually affect the skin, respiratory system, or digestive system.

 Non-IgE mediated milk allergy:

• Non-IgE-mediated reactions occur more slowly than IgE-mediated reactions.
• The most basic symptoms usually occur in the gastrointestinal tract.
• Reactions can begin even days after food intake.

Mixed type milk allergy:

• In mixed-type allergies, both IgE-mediated reactions and cell-mediated reactions are seen.
• Both rapid-onset symptoms and later-onset symptoms can be observed.
• It can be a combination of affecting both the skin and respiratory system as well as the gastrointestinal system.

These classifications describe how milk allergy can develop through different mechanisms and how quickly or slowly symptoms may appear. Each type of milk allergy is characterized by different symptoms and levels of severity.

How is milk allergy diagnosed?

There are many methods for diagnosing cow's milk allergy. However, to make an accurate diagnosis, it's important to have detailed information about the patient's dietary habits and symptoms. Diagnostic methods include:

• Patient history: Detailed information should be obtained regarding the timing and amount of food consumed, as well as any symptoms experienced. Symptoms such as indigestion, vomiting, and respiratory distress should be questioned.
• Physical examination: Allergy-related skin rashes, respiratory symptoms, or digestive system symptoms are evaluated through physical examination.
• Food provocation test: This is the evaluation of allergy symptoms by removing milk-containing foods from the diet for a certain period of time and then adding them back in a controlled manner.
• Specific IgE test: The possibility of allergy is evaluated by measuring specific IgE antibody levels against milk protein or other allergens with a blood test.
• Skin prick test: Liquid allergen extracts are dropped onto the skin and the reaction on the skin is observed.
• Atopy patch test: Allergic reaction is evaluated by applying strips of extracts of certain allergens to the skin.
• Total IgE test: Allergic condition is evaluated by measuring total IgE levels with a blood test.
• Elimination: A diet free of milk and dairy products is followed for a certain period of time and symptoms are observed to improve.
• Oral challenge test: Observing possible allergic reactions by consuming milk or dairy products in a controlled environment.

By using one or more of these tests, a correct diagnosis can be made and management of allergic reactions can be planned.

How should the mother of a baby with milk allergy be fed during breastfeeding?

It's important for breastfeeding mothers to pay attention to the nutrition of their babies with milk allergies. Here are some nutritional recommendations for mothers of babies with milk allergies who should follow during breastfeeding:

• Dairy-free diet: Mothers with a milk allergy should follow a dairy-free diet for their babies. They should avoid products such as milk, cheese, yogurt, cream, and kefir.
• Good reading habits: It's important to carefully read the ingredients on prepared foods you purchase. It's important to identify foods that may contain milk proteins and avoid them.
• Avoiding harmful foods: Not only milk and dairy products, but also harmful foods such as protein powders and cheese-making powders containing milk proteins should be avoided.
• Calcium supplements: A dairy-free diet can cause calcium deficiency in mothers with milk allergies. Therefore, mothers should use calcium supplements, but only after consulting with their doctor.
• Different animal milks: Goat and sheep milks may also be harmful to babies with a cow's milk allergy, as cross-reactivity can occur. Products containing these milks should also be avoided.
• Balanced and nutritious diet: If a mother is breastfeeding a baby with a milk allergy, she should follow a nutritious and balanced diet. This diet should include adequate protein, vitamins, and minerals.
• Communication with the Doctor: The mother should consult her doctor before making any changes to her diet. She should adjust her diet plan according to her doctor's recommendations.
• Continuing breastfeeding: Despite all these precautions, breastfeeding should continue. If breast milk is insufficient, safe, baby-friendly formula can be used as a supplement with a doctor's recommendation.

It is important to remember that every baby is different, so it is important to communicate with a healthcare professional to determine the most appropriate feeding plan for the health of mother and baby.

Choosing the right formula for babies with milk allergies

Breast milk is the ideal food for babies; however, in some cases, babies with milk allergies may require a special formula. Some special formulas that can be preferred for babies with milk allergies include:

• Highly hydrolyzed formulas: Hydrolyzed formulas are produced by breaking down the proteins in cow's milk. These formulas are a safe option for babies with milk allergies. Highly hydrolyzed formulas are among the recommended first choices for babies with milk protein allergies.
• Amino acid-based formulas: Amino acid-based formulas are special formulas that do not contain milk protein. These formulas are highly reliable and suitable for babies with severe milk allergies. Amino acid-based formulas may also be preferred for babies with multiple food allergies.
• Soy-based formulas: Soy-based formulas are an alternative option for babies with milk allergies. However, testing for soy allergy should be done beforehand. Soy-based formulas can be more cost-effective and offer better taste.
• Rice-based formulas: Babies generally like the flavor of rice-based formulas. While they are cost-effective, they are not recommended for preschoolers due to the toxicity of some of the ingredients they contain.

Important note: Every baby is different, and it's important to evaluate milk allergy issues under the supervision of a doctor. Formulas appropriate for your baby's needs should be selected with a doctor's advice. These recommendations are for general information only and should be based on a doctor's recommendation, taking into account individual medical conditions.

Cow's milk allergy treatment approaches

Food allergies are conditions without a definitive cure, but they require an approach focused on symptom management and prevention. Treatment for cow's milk allergy includes the following key elements:

• Eliminating allergenic foods from the diet: Breastfeeding mothers should eliminate cow's milk and dairy products from their diet. Babies should avoid formula containing cow's milk. This can help prevent allergic reactions.
• Education and awareness: Family members should be educated about allergies and made aware of the symptoms of allergic reactions. Being informed about what to do in an emergency is crucial.
• Treating symptoms: When symptoms of an allergic reaction occur, medications such as antihistamines can be used. However, these treatments are intended to relieve symptoms, not cure them.
• Emergency intervention: Individuals at risk of anaphylaxis may require an emergency adrenaline injection. Those who have had a previous anaphylaxis should be familiar with how to use adrenaline auto-injectors.
• Allergy monitoring: Allergies can change over time. Therefore, comprehensive allergy monitoring is important. Regular allergy testing should be performed under the supervision of a doctor.

Because food allergies can have serious consequences, they should be evaluated by a qualified healthcare professional when symptoms are noticed. Allergy treatment is individualized and may require a customized plan for each patient. Therefore, professional guidance is essential throughout the treatment process.