What is a milk allergy in adults

Allergies are an overreaction of the immune system as it tries to protect us from foreign proteins. In older kids and adults, the fight between your body and tell, cat dander or pollen, takes put “up high,” causing a runny nose or sneezing. But with infants, the allergy battleground is in the intestines. Here are the most common symptoms of milk allergies in infants.

  1. A lot of spitting up
  2. Vomiting
  3. Watery eyes, runny nose or stuffy nose
  4. Coughing or wheezing
  5. Slimy diarrhea or blood in stools
  6. Eczema (itchy red rash inside knees, elbows, neck) Scaly skin rash
  7. Hives
  8. Signs of abdominal pain (crying and grunting)
  9. Swelling (especially of the lips, tongue or throat)



Children who are allergic to cow’s milk are smaller and weigh less than peers who own allergies to peanuts or tree nuts, and these findings persist into early adolescence.

The results from the longitudinal study — believed to be the first to characterize growth patterns from early childhood to adolescence in children with persistent food allergies — was published online in The Journal of Allergy and Clinical Immunology.

«Published data about growth trajectories for kids with ongoing food allergies is scarce,» says Karen A. Robbins, M.D., lead study author and an allergist in the Division of Allergy and Immunology at Children’s National Hospital when the study was conducted. «It remains unclear how these growth trends ultimately influence how tall these children will become and how much they’ll weigh as adults.

However, our findings align with recent research that suggests young adults with persistent cow’s milk allergy may not reach their full growth potential,» Dr. Robbins says.

According to the Centers for Disease Control and Prevention, 1 in 13 U.S. children has a food allergy with milk, eggs, fish, shellfish, wheat, soy, peanuts and tree nuts accounting for the most serious allergic reactions. Because there is no cure and such allergies can be life-threatening, most people eliminate one or more major allergen from their diets.

The multi-institutional research team reviewed the charts of pediatric patients diagnosed with persistent immunoglobulin E-mediated allergy to cow’s milk, peanuts or tree nuts based on their clinical symptoms, food-specific immunoglobulin levels, skin prick tests and food challenges.

To be included in the study, the children had to own at least one clinical visit during three defined time frames from the time they were age 2 to age 12.

What is a milk allergy in adults

During those visits, their height and weight had to be measured with finish data from their visit available to the research team. The children allergic to cow’s milk had to eliminate it completely from their diets, even extensively heated milk.

From November 1994 to March 2015, 191 children were enrolled in the study, 111 with cow’s milk allergies and 80 with nut allergies. Every told, they had 1,186 clinical visits between the ages of 2 to 12. Sixty-one percent of children with cow’s milk allergies were boys, while 51.3% of children with peanut/tree nut allergies were boys.

In addition to children allergic to cow’s milk being shorter, the height discrepancy was more pronounced by ages 5 to 8 and ages 9 to 12.

And, for the 53 teens who had clinical data gathered after age 13, differences in their weight and height were even more notable.

«As these children often own multiple food allergies and other conditions, such as asthma, there are likely factors besides simply avoiding cow’s milk that may contribute to these findings. These children also tend to restrict foods beyond cow’s milk,» she adds.

The way such food allergies are handled continues to evolve with more previously allergic children now introducing cow’s milk via baked goods, a wider selection of allergen-free foods being available, and an improving understanding of the nutritional concerns related to food allergy.

Dr.

What is a milk allergy in adults

Robbins cautions that while most children outgrow cow’s milk allergies in early childhood, children who do not may be at risk for growth discrepancies. Future research should focus on improving understanding of this phenomenon.


Story Source:

Materials provided by Children’s National Hospital. Note: Content may be edited for style and length.


Journal Reference:

  • Karen A. Robbins, Robert A. Wood, Corinne A. Keet. Persistent cow’s milk allergy is associated with decreased childhood growth: Alongitudinal study.

    Journal of Allergy and Clinical Immunology, 2019; DOI: 10.1016/j.jaci.2019.10.028


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Cite This Page:

Children’s National Hospital. «Children allergic to cow’s milk smaller and lighter.» ScienceDaily. ScienceDaily, 20 December 2019. <www.sciencedaily.com/releases/2019/12/191220074250.htm>.

Children’s National Hospital. (2019, December 20). Children allergic to cow’s milk smaller and lighter. ScienceDaily. Retrieved January 29, 2020 from www.sciencedaily.com/releases/2019/12/191220074250.htm

Children’s National Hospital.

«Children allergic to cow’s milk smaller and lighter.» ScienceDaily. www.sciencedaily.com/releases/2019/12/191220074250.htm (accessed January 29, 2020).

Cow`s milk protein allergy is not a minor ailment, it is a serious disease. If untreated early and properly, it can pave the way for other serious illnesses, experts argued during a debate in Warsaw.

The theme of the debate was: «Milk allergy — a transient problem of infancy or a harbinger of further diseases».

The data presented during the discussion show that food allergies happen in 9-10% children. One of the most common food allergens is cow`s milk protein, to which 3% newborns and babies are allergic.

National paediatric gastroenterology consultant Prof. Mieczysława Czerwionka-Szaflarska warned against underestimating child`s food allergies, especially the cow`s milk protein allergy. «It`s not just a minor ailment, it is a serious disease» — she emphasized.

Along with other experts, she warned that if the allergy is not sufficiently early and properly treated, at a later age of the kid it may also pave the way for other allergic diseases, such as atopic dermatitis, bronchial asthma and allergic rhinitis. This especially applies to IgE-mediated allergy, which consists in the immune system producing IgE antibodies specific for cow`s milk proteins.

Allergy to cow`s milk protein generally has a mild, moderate form — explained Prof.

Piotr Albrecht, head of Department of Pediatric Gastroenterology and Nutrition of the Medical University of Warsaw. «In 90 percent children, food allergy generally disappears in the period from 2 to 4 years of age. However, if it is poorly treated, it threatens the development of the so-called allergic march, that is, the emergence of other allergic diseases» — he stressed.

Experts emphasized the importance of early detection of food allergy. Its symptoms may include eczema and skin rashes, diarrhoea, vomiting, constipation and gastro-oesophageal reflux, as well as respiratory ailments manifested by wheezing, coughing or sneezing, difficulty breathing, runny nose and swelling of the nose.

«Children affected by this type of allergies sometimes scratch every day, sleep badly and become nervous» — emphasized Prof. Albrecht. Some babies do not own serious symptoms, they only refuse to take food.

Cow`s milk protein allergy, especially in its mild and moderate form, can be diagnosed by a primary care physician. «A primary care physician can also prescribe allergy preparations that are refunded from the budget» — said Prof. Czerwionka-Szaflarska. The istration of such preparations, instead of the elimination diet, hard to implement in the case of cow`s milk protein, allows to avoid nutritional deficiencies.

The expert emphasised that when a kid receives milk for allergy sufferers, it should not be referred to a specialist, for example an allergist, because the specialist will not be capable to diagnose anything.

In any case, only children with severe food allergies, which in extreme cases may even lead to anaphylactic shock (life-threatening significant reduction in blood pressure), should be referred to specialists.

Head of the Chair and Clinic of Allergology and Clinical Immunology and Internal Diseases of the Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz Prof. Zbigniew Bartuzi noted that in some cases cow`s milk protein allergy may not be related to IgE antibodies.

It causes similar symptoms, such as diarrhoea, flatulence, intestinal discomfort, but they generally appear later (from 1 hour to a few days after exposure to cow`s milk protein).

The specialist warned that one should not use so-called alternative allergy tests, such as iridology and hair testing, to detect allergies. «They are not dependable and do not permit to make the correct diagnosis» — he stressed. He added that if they were useful, allergists would be using them. Doctors use so-called spot tests to check individual substances that may be sensitising.

Food allergy is also confused with food intolerance, caused by deficiency or lack of enzymes necessary for the proper digestion of nutrients.

In the case of cow`s milk, some people lack the enzyme (lactase) or it is not fully functional in the breakdown of lactose (disaccharide in the milk of mammals).

According to Prof.

What is a milk allergy in adults

Bartuzi, 30-35 percent Poles are cow`s milk intolerant, and some symptoms, such as stomach aches, bloating and diarrhoea in the form of foamy stools, may be similar to cow`s milk protein allergy. He noted that the age, at which cow`s milk tolerance appears, has been moved. In the 1990s, in 75 percent people it developed at the age of 5, and now on average at around 16 years of age. However, in an increasing number of people, it develops only during adulthood, or does not develop at all» — he explained.

Allergies are becoming more and more common.

According to the World Allergy Organization (WAO), 30-40 percent world population has at least one allergic disease, especially in the most industrialized countries. The Polish Allergy Society estimates that almost half of Poles are affected by allergies.

PAP — Science in Poland, Zbigniew Wojtasiński

zbw/ ekr/ kap/

tr.

What is a milk allergy in adults

RL

Milk Allergy in Infants

If your baby seems additional fussy, gassy, barfy, snorty or rashy you may wonder, “Can babies be allergic to breastmilk?” The answer? No, the natural breastmilk proteins are so mild that they just don’t provoke allergies in babies.

What is a milk allergy in adults

However, here’s the large BUT. Babies can be allergic to foods that you eat…tiny bits of which can sneak into your milk!

How do we know infants don’t get breastmilk allergies? In 1983, Swedish scientists proved that even colicky babies are totally fine with their mom’s milk, however, they can be allergic to proteins that pass through the mom’s intestines into her bloodstream and then into her milk.

And, those foreign invaders can sometimes create major hassles. About 10% of colic caused by a baby food allergy—most often the common allergenic foods, love dairy, soy, citrus, eggs, nuts, etc.—or food sensitivity—like caffeine in coffee, chocolate, ice tea, cola, Chinese herbs or decongestant medicine. (Most colic has nothing to do with the intestines.

It’s actually an imbalance of too much chaos and too much silent and too little rhythmic stimulation. That’s why fussy babies can often be soothed by the 5 S’s.)


make a difference: sponsored opportunity

Cite This Page:

Children’s National Hospital. «Children allergic to cow’s milk smaller and lighter.» ScienceDaily. ScienceDaily, 20 December 2019. <www.sciencedaily.com/releases/2019/12/191220074250.htm>.

Children’s National Hospital. (2019, December 20).

Children allergic to cow’s milk smaller and lighter. ScienceDaily. Retrieved January 29, 2020 from www.sciencedaily.com/releases/2019/12/191220074250.htm

Children’s National Hospital. «Children allergic to cow’s milk smaller and lighter.» ScienceDaily. www.sciencedaily.com/releases/2019/12/191220074250.htm (accessed January 29, 2020).

Cow`s milk protein allergy is not a minor ailment, it is a serious disease. If untreated early and properly, it can pave the way for other serious illnesses, experts argued during a debate in Warsaw.

The theme of the debate was: «Milk allergy — a transient problem of infancy or a harbinger of further diseases».

The data presented during the discussion show that food allergies happen in 9-10% children. One of the most common food allergens is cow`s milk protein, to which 3% newborns and babies are allergic.

National paediatric gastroenterology consultant Prof. Mieczysława Czerwionka-Szaflarska warned against underestimating child`s food allergies, especially the cow`s milk protein allergy. «It`s not just a minor ailment, it is a serious disease» — she emphasized.

Along with other experts, she warned that if the allergy is not sufficiently early and properly treated, at a later age of the kid it may also pave the way for other allergic diseases, such as atopic dermatitis, bronchial asthma and allergic rhinitis. This especially applies to IgE-mediated allergy, which consists in the immune system producing IgE antibodies specific for cow`s milk proteins.

Allergy to cow`s milk protein generally has a mild, moderate form — explained Prof. Piotr Albrecht, head of Department of Pediatric Gastroenterology and Nutrition of the Medical University of Warsaw.

«In 90 percent children, food allergy generally disappears in the period from 2 to 4 years of age. However, if it is poorly treated, it threatens the development of the so-called allergic march, that is, the emergence of other allergic diseases» — he stressed.

Experts emphasized the importance of early detection of food allergy. Its symptoms may include eczema and skin rashes, diarrhoea, vomiting, constipation and gastro-oesophageal reflux, as well as respiratory ailments manifested by wheezing, coughing or sneezing, difficulty breathing, runny nose and swelling of the nose.

What is a milk allergy in adults

«Children affected by this type of allergies sometimes scratch every day, sleep badly and become nervous» — emphasized Prof. Albrecht. Some babies do not own serious symptoms, they only refuse to take food.

Cow`s milk protein allergy, especially in its mild and moderate form, can be diagnosed by a primary care physician. «A primary care physician can also prescribe allergy preparations that are refunded from the budget» — said Prof.

Czerwionka-Szaflarska. The istration of such preparations, instead of the elimination diet, hard to implement in the case of cow`s milk protein, allows to avoid nutritional deficiencies.

The expert emphasised that when a kid receives milk for allergy sufferers, it should not be referred to a specialist, for example an allergist, because the specialist will not be capable to diagnose anything. In any case, only children with severe food allergies, which in extreme cases may even lead to anaphylactic shock (life-threatening significant reduction in blood pressure), should be referred to specialists.

Head of the Chair and Clinic of Allergology and Clinical Immunology and Internal Diseases of the Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz Prof.

Zbigniew Bartuzi noted that in some cases cow`s milk protein allergy may not be related to IgE antibodies.

What is a milk allergy in adults

It causes similar symptoms, such as diarrhoea, flatulence, intestinal discomfort, but they generally appear later (from 1 hour to a few days after exposure to cow`s milk protein).

The specialist warned that one should not use so-called alternative allergy tests, such as iridology and hair testing, to detect allergies. «They are not dependable and do not permit to make the correct diagnosis» — he stressed. He added that if they were useful, allergists would be using them.

Doctors use so-called spot tests to check individual substances that may be sensitising.

Food allergy is also confused with food intolerance, caused by deficiency or lack of enzymes necessary for the proper digestion of nutrients. In the case of cow`s milk, some people lack the enzyme (lactase) or it is not fully functional in the breakdown of lactose (disaccharide in the milk of mammals).

According to Prof. Bartuzi, 30-35 percent Poles are cow`s milk intolerant, and some symptoms, such as stomach aches, bloating and diarrhoea in the form of foamy stools, may be similar to cow`s milk protein allergy.

He noted that the age, at which cow`s milk tolerance appears, has been moved. In the 1990s, in 75 percent people it developed at the age of 5, and now on average at around 16 years of age. However, in an increasing number of people, it develops only during adulthood, or does not develop at all» — he explained.

Allergies are becoming more and more common. According to the World Allergy Organization (WAO), 30-40 percent world population has at least one allergic disease, especially in the most industrialized countries. The Polish Allergy Society estimates that almost half of Poles are affected by allergies.

PAP — Science in Poland, Zbigniew Wojtasiński

zbw/ ekr/ kap/

tr.

RL

Milk Allergy in Infants

If your baby seems additional fussy, gassy, barfy, snorty or rashy you may wonder, “Can babies be allergic to breastmilk?” The answer? No, the natural breastmilk proteins are so mild that they just don’t provoke allergies in babies. However, here’s the large BUT. Babies can be allergic to foods that you eat…tiny bits of which can sneak into your milk!

How do we know infants don’t get breastmilk allergies? In 1983, Swedish scientists proved that even colicky babies are totally fine with their mom’s milk, however, they can be allergic to proteins that pass through the mom’s intestines into her bloodstream and then into her milk.

And, those foreign invaders can sometimes create major hassles.

About 10% of colic caused by a baby food allergy—most often the common allergenic foods, love dairy, soy, citrus, eggs, nuts, etc.—or food sensitivity—like caffeine in coffee, chocolate, ice tea, cola, Chinese herbs or decongestant medicine. (Most colic has nothing to do with the intestines. It’s actually an imbalance of too much chaos and too much peaceful and too little rhythmic stimulation. That’s why fussy babies can often be soothed by the 5 S’s.)


Diagnosing Breastfeeding Allergies

Within 30 minutes of a mom eating a meal, tiny bits of proteins make it every the way from her stomach to her breast…and can hang out in there for hours.

As mentioned, the most common food allergies babies drop prey to are cow’s milk and soy, and much less common are eggs, nuts, citrus, wheat and shellfish. (The exact same things that cause allergies in large people.) Your doctor may recommend you go a week without consuming these foods (AKA an “elimination diet”…AKA chicken and water…ugh!) to see if the symptoms improve, which generally takes 3-7 days to notice. And then, if things do get better, your health care provider will likely own you do a food challenge, to see if the symptoms come back, which generally happens in just 1-2 days.

If you own concerns about your baby possibly having allergies (from fussing to huge spit ups to stringy, red tinged mucous in the poop), make certain you discuss that with your doctor or nurse practitioner.

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition.

It is only meant as general information. If you own any medical questions and concerns about your kid or yourself, please contact your health provider.

Frequently Asked Questions about Food Protein-Induced Enterocolitis Syndrome (FPIES)

What is FPIES?

FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea. FPIES is presumed to be cell mediated. Poor growth may happen with continual ingestion. Upon removing the problem food(s), every FPIES symptoms subside. (Note: Having FPIES does not preclude one from having other allergies/intolerances with the food.) The most common FPIES triggers are cow’s milk (dairy) and soy.

However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley.

A kid with FPIES may experience what appears to be a severe stomach bug, but the «bug» only starts a couple hours after the offending food is given. Numerous FPIES parents own rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, «It’s the stomach flu.» However, the next time they feed their children the same solids, the dramatic symptoms return.

What Does FPIES Stand For?

FPIES is Food Protein-Induced Enterocolitis Syndrome.

It is commonly pronounced «F-Pies», as in «apple pies», though some physicians may refer to it as FIES (pronounced «fees», considering food-protein as one word). Enterocolitis is inflammation involving both the little intestine and the colon (large intestine).

How Do I know If My Kid Has Outgrown FPIES?

Together with your child’s doctor, you should determine if/when it is likely that your kid may own outgrown any triggers. Obviously, determining if a kid has outgrown a trigger is something that needs to be evaluated on a food-by-food basis. As stated earlier, APT testing may be an option to assess oral challenge readiness. Another factor for you and your doctor to consider is if your kid would physically be capable to handle a possible failed challenge.

When the time comes to orally challenge an FPIES trigger, most doctors familiar with FPIES will desire to schedule an in-office food challenge.

Some doctors (especially those not practicing in a hospital clinic setting) may select to challenge in the hospital, with an IV already in put, in case of emergency. Each doctor may own his or her own protocol, but an FPIES trigger is something you should definitely NOT challenge without discussing thoroughly with your doctor.

Be aware that if a kid passes the in-office portion of the challenge, it does not mean this food is automatically guaranteed «safe.» If a child’s delay in reaction is fairly short, a kid may fail an FPIES food challenge while still at the office/hospital.

For those with longer reaction times, it may not be until later that day that symptoms manifest. Some may react up to three days later. Delay times may vary by food as well. If a kid has FPIES to multiple foods, one food may trigger symptoms within four hours; a diverse food may not trigger symptoms until six or eight hours after ingestion.

Is FPIES A Lifelong Condition?

Typically, no. Numerous children outgrow FPIES by about age three. Note, however, that the time varies per individual and the offending food, so statistics are a guide, but not an absolute.

In one study, 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three. However, only 40% of those with FPIES to rice, and 60% to dairy tolerated it by the same age.

What is Shock and What are the Symptoms?

Shock is a life-threatening condition. Shock may develop as the result of sudden illness, injury, or bleeding. When the body cannot get enough blood to the vital organs, it goes into shock.

Signs of shock include:
Weakness, dizziness, and fainting.
Cool, pale, clammy skin.
Weak, quick pulse.
Shallow, quick breathing.
Low blood pressure.
Extreme thirst, nausea, or vomiting.
Confusion or anxiety.

How Do You Care for a Kid With FPIES?

Treatment varies, depending on the patient and his/her specific reactions.

Often, infants who own reacted to both dairy and soy formulas will be placed on hypoallergenic or elemental formula. Some children do well breastfeeding. Other children who own fewer triggers may just strictly avoid the offending food(s).

New foods are generally introduced extremely slowly, one food at a time, for an extended period of time per food. Some doctors recommend trialing a single food for up to three weeks before introducing another.

Because it’s a rare, but serious condition, in the event of an emergency, it is vital to get the correct treatment. Some doctors provide their patients with a letter containing a brief description of FPIES and its proper treatment. In the event of a reaction, this letter can be taken to the ER with the child.

What are Some Common FPIES Triggers?

The most common FPIES triggers are traditional first foods, such as dairy and soy.

Other common triggers are rice, oat, barley, green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one common food does not mean that every of the common foods will be an issue, but patients are often advised to proceed with caution with those foods. Note that while the above foods are the most prevalent, they are not exclusive triggers. Any food has the potential to trigger an FPIES reaction. Even trace amounts can cause a reaction.

When Do FPIES Reactions Occur?

FPIES reactions often show up in the first weeks or months of life, or at an older age for the exclusively breastfed kid. Reactions generally happen upon introducing first solid foods, such as baby cereals or formulas, which are typically made with dairy or soy.

(Infant formulas are considered solids for FPIES purposes.) While a kid may own allergies and intolerances to food proteins they are exposed to through breastmilk, FPIES reactions generally don’t happen from breastmilk, regardless of the mother’s diet. An FPIES reaction typically takes put when the kid has directly ingested the trigger food(s).

How is FPIES Diagnosed?

FPIES is hard to diagnose, unless the reaction has happened more than once, as it is diagnosed by symptom presentation.

Typically, foods that trigger FPIES reactions are negative with standard skin and blood allergy tests (SPT, RAST) because they glance for IgE-mediated responses. However, as stated before, FPIES is not IgE-mediated.

Atopy patch testing (APT) is being studied for its effectiveness in diagnosing FPIES, as well as predicting if the problem food is no longer a trigger. Thus, the outcome of APT may determine if the kid is a potential candidate for an oral food challenge (OFC). APT involves placing the trigger food in a metal cap, which is left on the skin for 48 hours.

The skin is then watched for symptoms in the following days after removal. Please consult your child’s doctor to discuss if APT is indicated in your situation.

How Do You Treat an FPIES Reaction?

Always follow your doctor’s emergency plan pertaining to your specific situation. Rapid dehydration and shock are medical emergencies. If your kid is experiencing symptoms of FPIES or shock, immediately contact your local emergency services (9-1-1). If you are uncertain if your kid is in need of emergency services, contact 9-1-1 or your physician for guidance.

The most critical treatment during an FPIES reaction is intravenous (IV) fluids, because of the risk and prevalence of dehydration. Children experiencing more severe symptoms may also need steroids and in-hospital monitoring. Mild reactions may be capable to be treated at home with oral electrolyte re-hydration (e.g., Pedialyte®).

What is a Typical FPIES Reaction?

As with every things, each kid is diverse, and the range, severity and duration of symptoms may vary from reaction to reaction.

Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing or wheezing, etc. Symptoms typically only involve the gastrointestinal system, and other body organs are not involved. FPIES reactions almost always start with delayed onset vomiting (usually two hours after ingestion, sometimes as tardy as eight hours after). Symptoms can range from mild (an increase in reflux and several days of runny stools) to life threatening (shock).

In severe cases, after repeatedly vomiting, children often start vomiting bile. Commonly, diarrhea follows and can final up to several days. In the worst reactions (about 20% of the time), the kid has such severe vomiting and diarrhea that s/he rapidly becomes seriously dehydrated and may go into shock.

What Does IgE vs Cell Mediated Mean?

IgE stands for Immunoglobulin E. It is a type of antibody, formed to protect the body from infection, that functions in allergic reactions.

IgE-mediated reactions are considered immediate hypersensitivity immune system reactions, while cell mediated reactions are considered delayed hypersensitivity. Antibodies are not involved in cell mediated reactions. For the purpose of understanding FPIES, you can disregard every you know about IgE-mediated reactions.

Does FPIES Require Epinephrine?

Not generally, because epinephrine reverses IgE-mediated symptoms, and FPIES is not IgE-mediated.

Based on the patient’s history, some doctors might prescribe epinephrine to reverse specific symptoms of shock (e.g., low blood pressure). However, this is only prescribed in specific cases.

How is FPIES Diverse From MSPI, MSPIES, MPIES, Etc.?

MPIES (milk-protein induced enterocolitis syndrome) is FPIES to cow’s milk only. MSPIES (milk- and soy-protein induced enterocolitis syndrome) is FPIES to milk and soy. Some doctors do create these subdivisions, while others declare that milk and soy are simply the two most common FPIES triggers and give the diagnosis of «FPIES to milk and/or soy.»

MSPI is milk and soy protein intolerance. Symptoms are those of allergic colitis and can include colic, vomiting, diarrhea and blood in stools.

These reactions are not as severe or immediate as an FPIES reaction.

References

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. (2006). Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome. Pediatric Allergy and Immunology 17: 351–355. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_3/S116.

Burks, AW. (2006). Don’t Feed Her That! Diagnosing and Managing Pediatric Food Allergy. Pediatric Basics. Gerber Products Company: 115. Retrieved on December 31, 2007 from http://www.gerber.com/content/usa/html/pages/pediatricbasics/articles/115_01-dontfeed.html.

Moore, D.

Food Protein-Induced Enterocolitis Syndrome. (2007, April 11). Retrieved on December 31, 2007 from http://allergies.about.com/od/foodallergies/a/fpies.htm.

Sicherer, SH. (2005). Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons. Journal of Allergy and Clinical Immunology Vol. 115, 1:149-156. Retrieved on December 31, 2007 from http://www.jacionline.org/article/PIIS0091674904024881/fulltext.

Nowak-Wegrzyn, A., Sampson, HA, Wood, RA, Sicherer, SH. MD, Robert A. Wood, MD and Scott H. Sicherer, MD.

(2003). Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins. Pediatrics. Vol. 111. 4: 829-835. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/full/111/4/829#T1.

Nocerino, A., Guandalini, S. (2006, April 11). Protein Intolerance. Retrieved on December 31, 2007 from http://www.emedicine.com/ped/topic1908.htm. WebMD Medical Reference from Healthwise. (2006, May 31). Shock, Topic Overview.

Retrieved on December 31, 2007 from http://www.webmd.com/a-to-z-guides/shock-topic-overview.

American Academy of Allergy, Asthma and Immunology. (2007). Tips to Remember: What is an Allergic Reaction? Retrieved on December 31, 2007 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergicreaction.stm.

Sicherer, SH. (2006). Understanding and Managing Your Child’s Food Allergies. A Johns Hopkins Press Health Book. 336.

Medical Review February 2008.

University Photography

Paul Sherman, with a milk mustache and a glass of milk, which he says numerous people can’t digest because their ancestors lived in places where raising dairy cattle wasn’t safe or economical.

Got milk?

Numerous people couldn’t care less because they can’t digest it. A new Cornell University study finds that it is primarily people whose ancestors came from places where dairy herds could be raised safely and economically, such as in Europe, who own developed the ability to digest milk.

«The implication is that harsh climates and dangerous diseases negatively impact dairy herding and geographically restrict the availability of milk, and that humans own physiologically adapted to that,» said evolutionary biologist Paul Sherman, a professor of neurobiology and behavior at Cornell. «This is a spectacular case of how cultural evolution — in this case, the domestication of cattle — has guided our biological evolution.»On the other hand, most adults whose ancestors lived in extremely boiling or extremely freezing climates that couldn’t support dairy herding or in places where deadly diseases of cattle were present before 1900, such as in Africa and numerous parts of Asia, do not own the ability to digest milk after infancy.

Although every mammalian infants drink their mothers’ milk, humans are the only mammals that drink milk as adults.

But most people — about 60 percent and primarily those of Asian and African descent — stop producing lactase, the enzyme required to digest milk, as they mature. People of northern European descent, however, tend to retain the ability to produce the enzyme and drink milk throughout life.

Sherman and previous Cornell undergraduate student Gabrielle Bloom ’03, now a graduate student at the University of Chicago, compiled data on lactose intolerance (the inability to digest dairy products) from 270 indigenous African and Eurasian populations in 39 countries, from southern Africa to northern Greenland.

Their findings will be published in a forthcoming issue of Evolution and Human Behavior.

On average, Sherman and Bloom found that 61 percent of people studied were lactose intolerant, with a range of 2 percent in Denmark and 100 percent in Zambia. They also found that lactose intolerance decreases with increasing latitude and increases with rising temperature, and especially with the difficulty in maintaining dairy herds safely and economically.

A major challenge in interpreting the data, Sherman noted, was to resolve the puzzle that about 13 lactose-tolerant populations live side-by-side with lactose-intolerant populations in some parts of Africa and the Middle East.

«The most likely explanation is nomadism,» Sherman concluded.

Every 13 of the populations that can digest dairy yet live in areas that are primarily lactose intolerant were historically migratory groups that moved seasonally, Sherman said. Their nomadism enabled them to discover suitable forage for their cattle and to avoid extreme temperatures. «Also, the fact that these groups maintained little herds and kept them moving probably reduced the pathogen transmission rate.»

According to the National Digestive Diseases Information Clearinghouse, some 30 million to 50 million Americans are lactose intolerant, including up to 75 percent of African Americans and American Indians and 90 percent of Asian Americans.

Common symptoms include nausea, cramps, bloating, gas and diarrhea that start about 30 minutes to two hours after eating or drinking foods containing the milk sugar lactose. The use of lactase enzyme tablets or drops or lactose-reduced milk and similar products can assist the lactose intolerant digest dairy products.

Sherman’s study concludes that adults from Europe can drink milk because their ancestors lived where dairying flourished and passed on gene mutations that maintain lactase into adulthood.

The research, he said, is an example of Darwinian medicine, a new interdisciplinary field of science that takes an evolutionary glance at health, and considers why, rather than how, certain conditions or symptoms develop. Sherman, for example, recently investigated why spices are used and why morning sickness occurs.

«Both appear to serve an significant function to protect the individual,» Sherman said. «Spices contain antimicrobial compounds, and they may be used to destroy food-borne pathogens, especially in boiling climates.

Nausea and vomiting early in pregnancy also may protect women and their embryos from food-borne pathogens and other toxins.»

A Darwinian medicinal view complements traditional medicine, Sherman said, because if researchers can better understand why a symptom occurs, such as a fever, runny nose or allergy, they can better assess whether it is best to eliminate or tolerate it.


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