ENT AND ALLERGY CENTRE(INDIA)PANCHKULA

1. ENT AND ALLERGY CENTRE(INDIA)PANCHKULA www.entandallergycentre.webs.com

2. RESPIRATORY DISEASES AND CLINICAL IMMUNOLOGY SOCIETY REGD • www.rdcispanchkula.webs.com

3. COWS MILK ALLERGY

4. Cow milk for infants: A tradition best forgotten When it comes to nutritional practices and beliefs, many women seem to place great faith in our tradition

5. IN OUR LAND • In our land, when an infant is weaned from mother’s milk, it has traditionally been the practice to replace the mother’s milk with cow’s milk • This can have unpleasant consequences • One of the most common food allergies happens to be the allergy to milk (both cow’s and buffalo’s milk)

6. GLOBAL CHALLENGE • Data suggests that cow milk allergy affects more than 2 per cent of the infant population all over the world. • CMA is a global challenge and collaboration of the national and international scientific communities is essential to produce and update practical guidelines for CMA.

7. REVIEW • Even though there seems to be uniformity concerning the diagnosis and treatment of CMA, the diagnostic approach to CMA shows variations among different regions. Common concerns were inadequate applications of challenge tests for the diagnosis and inadequate supply of the cow's milk substitute formulas.

8. MILK IS MOST PREVALENT FOOD ALLERGEN • In the majority of individuals the immune system recognises these proteins as harmless and tolerates them in the body, however in CMA individuals, the immune system becomes sensitised and reacts to the proteins by mounting a damaging inflammatory response. • Of the 8 most prevalent food allergies, cow’s milk allergy is the most common amongst infants. It usually develops early in infancy when susceptibility is highest and soon after exposure to cow’s milk infant formula.

9. MILK IS MOST PREVALENT FOOD ALLERGEN • allergies have increased over the past decade and are an important problem in daily clinical practice. • They affect 6% of children and 3 to 4% of adults. Furthermore, around 20% of the population falsely believe that they are allergic to some foods and follow unnecessarily restrictive diets.

10. FOODS RESPONSIBLE FOR ALLERGIES • milk, eggs, wheat, peanuts, nuts,fish, shellfish. • Of these, cow’s milk allergy is frequently suspected in small children. It can be responsible of a variety of symptoms and can be caused by IgE-mediated or non-IgE-mediated reactions

11. HUMAN MILK IS FREE FROM BETA-Ig • Cow milk contains more than 20 proteins (allergens), that can cause allergic reactions. Casein fractions and beta-lactoglobulin are the most common cow milk allergens. Human milk is free of beta-lg,

12. REVIEW OF DIFFERENT RESEARCHERS • According to Robert Cohen, Executive Director of the Dairy Education Board and NOTMILK.com • milk consumption is to blame for a variety of health woes, including the following: • breast cancer • diabetes (both diabetes mellitus and juvenile diabetes) • kidney stones • acne • heart disease • osteoporosis • multiple sclerosis • stroke • rheumatoid arthritis

13. http://www.llli.org/FAQ/bflength.htmhttp://www.notmilk.com/http://saveourbones.com/osteoporhttp://www.llli.org/FAQ/bflength.htmhttp://www.notmilk.com/http://saveourbones.com/osteopor

14. HomeNews & Issues3.Animal RightsAnimal RightsMilk and Human Health

15. By Doris Lin, About.com Guide

16. S MILK. Dr. Kerrie Saunders states, \ • While cow’s milk is high in calcium, it is also high in protein. Excess protein in our diets causes calcium to leach out of our bones. Dr. Kerrie Saunders

17. Benjamin Spock, the U.S.'s leading authority on child care, • Benjamin Spock, the U.S.'s leading authority on child care, spoke out against feeding "cow's glue" to children, saying it can cause anemia, allergies, and diabetes and in the long term, will set kids up for obesity and heart disease, the number one cause of death in this country

18. .Milk is a serious health threat • The time has come for the milk industry to face the kind of scrutiny that the tobacco companies face today. Meanwhile, discard the moo juice.

19. MILK CAN BE ONE OF THE ..Tell Youth the Truth About ..Tell Youth the Truth About Politics and Disease.. • It’s time to demand that politicians stop their money-grubbing ways and show some true concern for the people they’re supposed to represent. • For solid health information, please visit • http://www.all-creatures.org/health.html • For great-tasting, healthful recipes please visit:http://www.all-creatures.org/recipes.html • T Y T T:

20. COWS MILK ALLERGY SHOULD BE SUSPECTED IN CHILDREN • A joint study group on cow’s milk allergy was convened by the Emilia-Romagna Working Group for PaediatricGastroenterology to focus best practice for diagnosis, • management and follow-up of cow’s milk allergy in children and to offer a common approach for allergologists,gastroenterologists, general paediatricians and primary care physicians. • The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas.

21. COWS MILK ALLERGY • Cow’s milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough,vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis

22. LATE REACTIONS WITH COWS MILK ALLERGY • Late reactions due to cow’smilk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy

23. MY EXPERIENCES AND STUDIES ON CMPA • STUDY WAS DONE ON CHILDREN WITH ASTHMA AND BRONCHITIS ATTENDING THE ENT AND ALLERGY CENTRE • AGE GROUP WAS FROM 5 – 14 YEARS

24. STUDY OF MILK ALLERGY IN CHILDREN • Skin prick allergy tests were done in our centre. Only those children were taken for study who showed only single allergen milk.The skin prick test results were confirmed by elisa tests.80 %patients who showed positive reaction to milk  also had elisa test positive.

25. MANAGEMENT • We ELIMINATED THE ALLERGEN • FOLLOWED UP FOR LONG TIME. • AND AFTER ELIMINATION WE WERE ABLE TO FIND OUT THAT THERE WAS LOT OF IMPROVEMENT IN THE SYMPTOMS AND SIGNS OF PATIENTS DIAGNOSED BY DOUBLE CONFIRMATION

26. NATURAL COURSE OF CMA • The natural course of CMA is acquisition of tolerance through elimination diet and 80%patients overcome by the time they are 4-5 years. • Beyond 5 years of age we should still think one of the factors in allergic diseases

27. Although oral tolerance mechanisms are not completely understood, CMA is usually transient and tolerance has been reported in up to 80% of the children by the age of two Children with non-IgE-mediated disease have been shown to develop tolerance earlier and more frequently than those with IgE-mediated CMA Persistence of cow's milk allergy beyond two years of age Dias, A.; Santos, A.; Pinheiro, J.A. Publicado en Allergol Immunopathol (Madr).2010; 38(01) :8-12 - vol.38 núm 01

28. However, allergy persists beyond the age of two in some children • However, allergy persists beyond the age of two in some children, in whom CM avoidance and specialised follow-up have to be continued. In spite of limited information on the acquisition of tolerance to CM in children with more persistent disease, recent data has shown a change in natural history of CMA, with increasing persistence until later age.

29. PERSISTENCE OF CMA BEYOND 5 YEARS OF AGE • STUDY IN ENT AND ALLERGY CENTRE • THE STUDY INCLUDED CHILDREN 6 MONTHS ONWARDS AND SELECTED ADULTS CUTANEUS RESPIRATORY AND GI SYMPTOMS

30. OUR AIM OF THIS STUDY • TO Study CMA in chidren beyond five years of age to determine effect of its avoidance in children suffering from various forms of allergic ailments

31. FIFTY ONE SUBJECTS • Fifty one patients having positive history of CMA were included in the study .Majority of the patients showed sensitivity toCMA who had respiratory allergies(30.2%)cutaneous sensitivity(50.5%)and gastrointestinal menifestation(20.3%.)

32. CONCLUSION • Many Children continue to have chronic symptoms even the origional problem may disappear.That means some children may have an allergic tendency that persists after 5 years of age

33. Alabama who describes Dr. Oski’s Dr. J. Dan Baggett, a pediatrician in Alabama who describes Dr. Oski’s book includes a letter written by his experience • after six years of recommending that all his patients eliminate cow’s milk from their diets. He writes, “In general, they cooperate much better than I had earlier anticipated except for the pre-teenagers and teenagers.” • During the years 1963 through 1967 • I do not have a single patient with active asthma. In fact, I have nearly forgotten how to prescribe for them.

34. ON HIS EXPERIENCE • A study was done in which every child of allergic bronchitis was selected and prick tests done and confirmed by RIA tests in which around 95% cases were positive to milk and they responded well by elimination

35. MANAGEMENT • ELIMINATION DIETS

36. Oral Desensitization in ChildrenWith Cow’s Milk AllergyL Zapatero, E Alonso, V Fuentes, MI MartínezAllergy Department, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain■

37. DESENSITISATION WITH COWS MILK DROPS • We propose a cow’s milk desensitization • protocol carried out in an outpatient setting over a 9-10 week period.

38. Patients and method: • Eighteen children older than 4 years with cow’s milk protein allergy underwent a desensitization protocol beginning with 0.05 ml of cow’s milk, reaching 1 ml on the first day, and increasing the dosage weekly until a dose of 200-250 ml of milk taken once a day was tolerated. • Results: By the end of the desensitization protocol, 16 of the 18 patients tolerated 200-250 ml of cow’s milk in a single daily

39. ORAL DESENSITISATION WITH MILK DROPS • Conclusions: Tolerance of cow’s milk was achieved in 16 out of 18 patients who took part in this study. One patient only tolerated 40ml,which prevents the risk of reactions caused by the inadvertent intake of the food substance; 1 patient is still on a milk-free diet. We believe this cow’s milk desensitization protocol to be effective and reasonably safe.

40. 'Milk Drops' Under the Tongue Appear to Treat Milk Allergies • ScienceDaily (Mar. 1, 2010) — Placing small amounts of milk protein under the tongues of children who are allergic to milk can help them overcome their allergies, according to the findings of a small study at Johns Hopkins Children's Center and Duke University.

41. TRIAL OF SUBLINGUAL IMMUNOTHERAPY IN CHILDREN • A STUDY IS ON THE WAY FOR SUBLINGUAL IMMUNOTHERAPY IN THE CHILDREN SUFFERING FROM MILK ALLERGIES • THE STARTING RESPONSE IS GOOD

42. (By Eric SchultzNEW YORK | Thu Jun 2, 2011 5:37pm EDT • Reuters Health) - Eating baked goods that contain milk may help children get over milk allergies, a new study suggests.

43. Allergic children given cooked milk, baked into muffins, over the course of months or years saw their symptoms disappear faster than children who simply avoided milk products. • The researchers say their results have the potential to change how kids are treated for milk allergies -- which affect as many as three percent of young children, according to the National Institute of Allergy and Infectious Disease.

44. MILK ALLERGY AND LECTOSE INTOLERANCE • Milk allergy is not the same as lactose intolerance, which is an inability to digest milk products. Kids with allergies can react to the proteins in milk and cheese with symptoms ranging from mild itching to potentially deadly anaphylactic shock.

45. MILK CAN BE ONE OF THE COWS MILK CAN BE MAJOR CAUSES FOR ALLERGIES IN CHILDREN BUT IT SHOULD LSO BE KEPT IN MIND FORFINDING THE CAUSE OF ALLERGIES IN ADULTS ALSO

46. CONCLUSION • ANIMAL PROTEINS REACT WITH THE HUMAN PROTEINS IN CASES OF PATIENTS SUFFERING FROM ALLERGIC PROBLEMS