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Paediatrics finals > Cows milk protein allergy > Flashcards

Cows milk protein allergy Flashcards

1
Q

What is cows milk protein allergy?

A

Immune mediated allergic response to naturally occurring proteins caseins and whey in cows milk

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2
Q

How is cows milk protein allergy classified?

A

IgE mediated
Non-IgE mediated
Mixed

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3
Q

How common is cows milk protein allergy?

A

7% of formula or mixed fed infants

0.5% exclusively breast fed infants

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4
Q

What is a protective factor for cows milk protein allergy?

A

Breastfeeding

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5
Q

Describe IgE mediated cows milk protein allergy

A

A type 1 hypersensitivity reaction
CD4 TH2 cells stimulate B cells to produce IgE antibodies against cows milk protein which trigger release of histamine and other cytokines from mast cells and basophils

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6
Q

Describe non-IgE mediated cows milk protein allergy

A

Involves T activation against cows milk protein

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7
Q

What are the risk factors for cows milk protein allergy?

A

Personal or family history of atopy

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8
Q

How are symptoms of cows milk protein allergy classified?

A 
Speed of onset after exposure
GI
Skin
Resp 
Aetiology of the allergy
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9
Q

Describe the clinical presentation of IgE mediated cows milk protein allergy

A

Acute and frequently rapid onset - within 2 hours of exposure
Skin - pruitis, erythema, acute urticaria (localised or generalised), acute angio-oedema (lips, face, eyes)
GI - Oral pruitis, nausea, colicky abdo pain, vomiting and diarrhoea
Resp - lower (cough, chest tightness, wheeze or SOB) and upper (nasal itching, sneezing, rhinorrhoea, congestion)

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10
Q

Describe the clinical presentation of non-IgE mediated cows milk protein allergy

A

Non-acute and generally delayed - manifest after 48hours to 1 week after ingestion
Skin - pruitis, erythema, atopic eczema
GI - GORD, loose or frequent stools, Blood/mucus in stool, abdo pain, infantile colic, food refusal/aversion, constipation, perianal redness, faltering growth in conjunction with GI symptoms
Resp - Lower (cough, tight chest, wheeze, SOB)

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11
Q

List the questions needed to be asked in an allergy focused history for CMPA

A 
Personal and family history of atopy 
Diet and feeding history of infant
Diet and milk ingestion of the mother if breast feeding
Any previous management for symptoms
Which milk/foods
Age of onset
Speed of onset following exposure
Duration
Frequency and severity 
Settling of reaction 
Reproducibility of symptoms
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12
Q

What examination is required for CMPA?

A

GI
Look for malnutrition signs
Growth charts
Signs of atopic conditions - asthma, eczema, allergic rhinitis

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13
Q

List some differentials of CMPA

A 
Food intolerance
Allergic reaction to food
Anatomical abnormalities - Meckel's diverticulum 
Chronic GI disease
Pancreatic insufficiency 
UTI
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14
Q

How is CMPA diagnosed?

A

Non-IgE mediated - clinically
IgE mediated - RAST test
Haematinics useful to diagnose iron deficiency

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15
Q

Describe the RAST test

A

Radioallergosorbent test - detects IgE antibodies to cows milk allergy

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16
Q

Describe the usefulness of the RAST test

A

Very sensitive but not very specific

High false positive rate

17
Q

How is cows milk protein allergy managed?

A

Avoidance of cows milk in all forms including mothers breastmilk - elimination diet for 6 months or until infant is 9-12 months with re-evaluation every 6-12 months to assess for tolerance of cows milk protein

Nutritional counselling

Monitoring of growth

Replacement of formula milk

18
Q

Which guideline ladder may be helpful for patients with CMPA?

A

MAP milk ladder

19
Q

Which two milks can formula milk be replaced with in CMPA?

A

Extensively hydrolysed formula

Amino acid formula

20
Q

Describe the extensively hydrolysed formula

A

Cheaper, first line formula made with cows milk but with casein and whey broken down into smaller peptides which are less immunogenic

21
Q

What percentage of patients will respond to extensively hydrolysed formula?

A

90%

22
Q

Describe amino acid formula

A

Used for the 10% who do not respond to extensively hydrolysed formula or who have very severe symptoms
More expensive
2nd line

23
Q

Why are soya based formulas not recommended in infants <6mo?

A

Weak oestrogenic effects of isoflavones and absorption of minerals and trace elements may be inhibited by phytate found in this milk

24
Q

What are the complications of cows milk protein allergy?

A

Malabsorption
Reduced intake
Fe deficiency anaemia
Faltering growth

Paediatrics finals (37 decks)

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