updated 14 Jan 2012, 15:04
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Wed, Aug 10, 2011
The Star/ANN
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Problem with protein
by Wong Li Za

DR EMILIA Mohtar breastfed her son Adrian Zidane for three months before putting him on soy-based formula at her paediatrician sister's suggestion.

"There is a history of allergies such as eczema and asthma in our family, hence her proposal," said Dr Emilia, 34, who has rhinitis (stuffy nose) and dermatitis (inflammation of the skin) herself.

Then when Adrian was one year old, she tried giving him cow's milk formula but the boy threw it all up.

Dr Emilia, who's an anaesthetist at Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur, went back to giving her first child soy-based milk.

When her son was three, she tried to switch again to cow's milk formula but to no avail. Adrian, her only child, is now four years old.

Adrian's is a case of cow's milk protein allergy (CMPA), which is commonly mistaken for lactose-intolerance. It's important for parents to differentiate between the two in order to take the appropriate steps to manage their child's condition.

An overwhelming 95% of food allergies arise from reactions to cow's milk protein, soy, seafood (mainly shellfish) and nuts, especially peanuts, as Dr Khoo Keh Bin pointed out.

"Most food allergies are due to the protein that is in the food," the consultant paediatrician added at a CMPA awareness talk with the media in Kuala Lumpur recently. Dr Emilia and Adrian were present at the event.

Allergies in children have been on the rise over the decades.

According to research, total allergies in children in developed countries have increased sharply from 5% in the 1960s to 35% in 2000.

Food allergies, which are due to a malfunction in the body's immune system, in general affect 6% of children and 2% of adults. Environmental factors like air, water and food can also trigger allergies.

What is CMPA?

It is basically an allergy to the protein in cow's milk. Most children who have an allergic reaction to cow's milk will also be allergic to goat's or sheep's milk.

There are two types of proteins in cow's milk that can cause an allergic reaction: casein, which is found in the solid part of milk that curdles; and whey, present in the liquid part of milk that remains after milk curdles.

A child may be allergic to only one milk protein or both casein and whey.

Fully-breastfed babies can also develop CMPA as a result of the mother's high consumption of dairy products.

On the other hand, lactose intolerance is due to the deficiency of the enzyme lactase, which is needed to fully digest milk sugar, or lactose.

Dr Khoo, whose focus is on preventive medicine like immunisation, nutrition and allergies, said the prevalence of CMPA in Asia is about 2% to 3% .

"It's not easy to put an accurate figure because sometimes parents assume their child is allergic to something else when it's actually CMPA," he said.

If one parent has CMPA, the child has a 20%-40% chance of developing it. If both parents have CMPA, then the chances go up to 50%-70%.

CMPA tends to go off by itself as the child grows older, with ages and percentages outgrowing it as follows: after age four - 19%; after age eight - 42%; and over 16 years old - 80%. "Somehow the body will develop a tolerance to the protein," explained Dr Khoo.

Affected areas

Symptoms of CMPA can be felt in three areas of the body: respiratory, gastrointestinal system and skin.

> Under respiratory, signs include asthma, wheezing, cough and rhinitis while severe symptoms are breathing difficulty and swelling of the airways, causing anaphylaxis, which is a severe allergic reaction. (A sudden drop in blood pressure, a sign of anaphylaxis, is also a serious symptom of CMPA.)

> Gastrointestinal symptoms include vomiting, severe regurgitation, diarrhoea, constipation, colic, bloatedness and even blood in the stool. The long-term effects of these symptoms may lead to poor weight gain.

> As for skin, children can develop eczema or atopic dermatitis, hives and rashes on the cheek, arm folds or thigh folds. Severe symptoms include heightened itchiness, which disrupts sleep and may later become infected.

CMPA symptoms can arise immediately after a child consumes the milk but they can also surface later as a delayed reaction.

Instant reactions appear within the first 45 minutes, while medium-delayed symptoms show up between 45 minutes and 24 hours. Delayed symptoms present after one day or up to one to two weeks later.

"Therefore, it's difficult to diagnose this allergy," said Dr Khoo.

Tests available for CMPA are through blood, skin prick and skin patch, for the severe cases.

"What parents can do when they suspect that their child is allergic to cow's milk formula is to stop giving them the milk completely and see if symptoms reduce. Then, reintroduce the milk to see if symptoms return. This is a more practical way of detecting CMPA," he advised.

Parents should consider cow's milk formula substitutes "only when you are quite sure that it's CMPA".

"However, I want to emphasise that breastfeeding exclusively is still very important in infants and toddlers," he added.

Cow's milk formula substitutes include extensive hydrolised formulas and amino acid-based formulas. Hypoallergenic formulas in the market are partially hydrolised formulas, which are not suitable for treatment of CMPA, he reminded.

Another option is soy-based formulas. However, according to Dr Khoo, about 10%-13% of babies with CMPA are also allergic to soy milk. These babies can opt for the hydrolised or amino acid-based formulas.


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