Scarlett Salman, Lynn Christie, Wesley Burks, Mccabe-Sellers.

Dietary Intakes of Children With Food Allergies: Comparison of the Food Guide Pyramid
and the Recommended Dietary Allowances 10th

Ed. J Allergy Clin Immunol 2002; 109 (1: Part 2): Abstract 643

ABSTRACT

Cow's milk is considered as a cause of food allergies in children are the most frequent and
earliest encountered in life. Cow's milk allergy is a disease based on immunological reactions
that arise as a result of cow's milk or foods containing cow's milk. Cow's milk allergy is a
collection of symptoms that on many organs and body systems caused by allergies to cow's milk.
Recent research also revealed that food allergies may interfere with children's behavior as
hiperkinetik disorders, concentration problems, sleep disturbances or aggravate autism.

Diagnosis of cow's milk allergy is a clinical diagnosis of a careful anamnesis, observing

signs of atopic on physical examination, examination of total and specific immunoglobulin E to
cow's milk. To ensure a cow's milk allergy should use a blind food provocation (Double Blind
Placebo Control Food Chalenge = DBPCFC). DBPCFC is the gold standard or gold standard.
DBPCFC method, however is very complicated and requires time, is impractical and cost is not
small. Some allergic child care center to modify the way it was. Allergy Center Children's
Hospital Mother of Jakarta to modify a manner that is simple, cheap and quite effective.
DBPCFC modification by doing "Open Food Simplified Elimination Provocation."

Detection and prevention of cow's milk allergy should be taken carefully from the outset.
Pitfall diagnosis of cow's milk allergy because the symptoms are often experienced symptoms
similar to the intersection of reaction to cow's milk formula components and the influence of
maternal diet during breastfeeding.
 INTRODUCTION

Hippocrates first reported the reaction to cow's milk around the year 370 BC. In recent
decades the prevalence of and attention to cow's milk allergy is increasing. Cow's milk is often
considered a cause of food allergy in children most frequently Some studies in several countries
around the world the prevalence of cow's milk allergy in children in the first year of life of about
2%. Approximately 1-7% of infants in general suffer from allergies to the protein contained in
cow's milk. While approximately 80% of baby formula on the market was using the basic
ingredients of cow's milk.

Cow's milk allergy is a collection of symptoms that on many organs and body systems
caused by allergies to cow's milk with the involvement of immune mechanisms. Mechanism of
reaction to milk which is essentially the reaction of type I and hipersensitifitas hipersensitifitas of
food that is essentially a reaction hipersensitifitas type III and IV. Intersection of food reactions
that do not involve the immune system mechanisms known as milk intolerance .. Allergic to
cow's milk protein allergy to milk or formula containing cow milk protein is a situation where
someone has a system of an abnormal immune reaction against proteins contained in cow's milk.
Baby's immune system will fight the proteins contained in cow's milk so that the symptoms of
allergic reaction will occur.

Cow's milk allergy will be 85% will disappear or become tolerant before the age of 3
years. Handling of cow's milk allergy is the avoidance of cow's milk and foods containing cow's
milk, soy milk by giving until there is tolerance towards cow's milk. The contrast between
allergic diseases are allergic to cow's milk and other foods in infants is that tolerance can occur
spontaneously during early childhood.

Avoidance of cow's milk should be done until there is tolerance around the age of 2-3
years and should be given milk substitute for cow's milk formula or soya hydrolyzate perfect and
free of solid foods and cow's milk dairy cows. Prevention of allergy should be done as early as
possible at-risk atopic children, research shows that 85% ASS will be tolerated before the three-
year-old child. Although tolerance would occur in that age, preventive measures and proper
governance necessary to prevent a more severe allergy and food allergy to other allergens in the
future.

Allergy is an important issue that should not be underestimated. Generated can interfere
with the reaction of all organs of the body and behavior of children. So that it can disrupt the
growth and development of a child. At the age of the first year of life, a child's immune system is
still relatively immature and very vulnerable. If he has the talent and atopic tersensitisasi will
easily develop into diseases such as allergic to certain food allergens and inhalan.

Pathogenesis
Cow's milk allergy occurs because the defense mechanisms of specific and non-specific
gastrointestinal baby is not perfect. Cow's milk is the main foreign protein given to an infant,
should be distinguished between the cow's milk allergy an immunological reaction and
intolerance reactions which are not based on immunological disorders such as toxic effects of
bacterial stafilokok, metabolic defects caused by lack of lactase enzyme, reaction or reaction
idiosinkrasi intersection of materials other substances contained in milk formulas.

Cow's milk protein is the most common allergens in a variety of hypersensitivity

reactions in children. Cow's milk contains at least 40 protein components that may interfere with
immune responses that deviate to a person. Cow's milk proteins casein and whey was divided
into. Casein in the form of condensed milk is usually obtained in the form composed of 76-86%
of cow's milk protein. Casein can dipresipitasi with acid at pH 4.6. Whey comprises 20% of total
milk protein, which consists of β-lactoglobulin (9% of total milk protein), α-lactalbumin (4%),
bovine immunoglobulin (2%), bovine serum albumin (1%), and a small number proteins such as
lactoferrin, transferrin, lipases (4%). With regular pasteurization is not sufficient to eliminate this
protein but rather enhance the nature alergenitas some milk proteins such as b-laktoglobulin.
Characteristics of cow's milk protein components.

PROTEIN MOLECULAR PERCENTAGE ALERGINISITAS STABILITY IN

COMPONENT WEIGHT (kD) OF TOTAL THE
PROTEIN TEMPERATURE
100 C
β -lactoglobulin 18.3 10 +++ ++
Casein 20-30 82 ++ +++
α -lactalbumin 14.2 4 ++ +
Serum albumin 67 1 + +
Immunoglobuli 160 2 +
ns

Many studies concerning alergenitas cow's milk protein. There are more than 40 different
types of protein in cow's milk which has the potential to cause sensitivity. The content of cow's
milk allergy is the most frequent cause lactoglobulin, casein hereinafter, lactalbumin bovine
serum albumin (BSA). Immunoelectrophoretic analysis showed that casein reduced
alergenisitasnya after heating around 120 C for 15 minutes, while lactoglobulin, lactalbumin
decreases towards heating more than 100C. BSA and gammaglobulin lost antigenisitasnya at a
temperature between 70C - 80C.

Full warming will occur from some whey protein denaturation. β-lactoglobulin is the
most powerful cause of allergens. Other studies mention the antibody IgE antibody against α-
lactalbumin, β-lactoglobulin, bovine serum albumin, and bovine gamma globulin is the most
common cause of allergies in humans, whereas caseins were the cause of most allergies. Recent
research mentioned casein-specific IgE was found 100% in the group of allergy sufferers, β-
lactoglobulin IgE from approximately 13%, α-lactalbumin around 6%.
 Clinical Manifestations

Symptoms that occur in cow's milk allergy in general is almost the same as any other food
allergy symptoms. The main target organ reaction to cow's milk allergy is the skin,
gastrointestinal and respiratory tract. Reaction of acute (short term), which often happens is itchy
and anaphylaxis. While the reaction of chronic (long term), what happens is astma, dermatitis
(eczema skin) and gastrointestinal disorders. Some manifestations of reactions to cow's milk
through the intersection because of IgE and non IgE mechanisms.

Target organs are often affected is the skin form of urticaria and angioedema.
Gastrointestinal system is affected is oral allergy syndrome, gastrointestinal anaphylaxis, allergic
eosinophilic gastroenteritis. Airways that occurs is asthma, colds, chronic coughing repeatedly.
Target multiorgan form of anaphylaxis due to anaphylaxis triggered by food or food-related
activities

In addition to the target organ is often the case mentioned above, manifetasi other clinical
manifestations such as unusual (Anussual Manifestation). Among them are the skin
manifestations such as vasculitis, fixed Skin Eruption. Disturbed gastrointestinal system is
chronic Pulmonary disease (Heiner syndrome), hypersensitivity pneumonitis. Gastrointestinal
tract that occurs is constipation, gastroesophageal reflux, bronchial hypersecretion and airway
obstruction lakrimalis duct naso. Target multiorgan form of irritability / Sleeplessness in Infants,
artropati, nephropathy and thrombocytopenia. Several other studies mentioned food allergy
including cow's milk may interfere with the child's behavior such as sleep disorders,
hyperactivity, emotional disturbances, impaired concentration, and aggravate the symptoms of
autism.

Reaction to cow's milk that may arise due to non-IgE reaction in the form of atopic
dermatitis, herpetiformis ermatitis, proktokolitis, entero colitis, allergic eosinophilic
gastroenteritis, enteropathy syndrome, celiac disease and Heiner syndrome
 There are three clinical patterns of response of milk protein allergy in children: Rapid
Response, the time from after drinking the milk until the onset of symptoms. The reaction
medium (pencernaa), 45 minutes to 20 hours. While Slow Reactions (skin and sal.cerna), More
than 20 hours. The initial reaction of skin symptoms occur within 45 minutes after consuming
milk. These reactions can be either red spots (like measles) or itching. Other symptoms such as
respiratory tract system disorders such as breath sounds' ngik "(wheezing), or
rhinoconjuncytivitis (sneezing, itchy nose and eyes, and red eyes). Symptoms such bias occurs
even if only consume a little cow's milk. Hill et al have mellaporkan that almost all (92% of
patients in this group in skin prick test to cow's milk positive results .. Anaphylaxis to cow's milk
is the most important reactions in this group.

In the group of reactions are symptoms that often arise are vomiting, diarrhea start after 45
minutes to 20 hours after getting the exposure it with milk. According to research, around one
third of this group showed positive results of skin tests (skin prick test).

The symptoms of slow reaction occurs in about 20 hours after exposure susus affected
cows. For this reaction required volume large enough to cow's milk. In this group only about
20% who obtained a positive skin test results. Outboard allergy test (Patch Test) conducted
during the 48 hours there is often a positive outcome in this group. Most occur in more than six
months of age. Signs and symptoms that often arise are diarrhea, constipation (hard money big
water) and dermatitis (skin disorder).

Some studies indicate an allergy to cow's milk around 80% will disappear or become
tolerant before the age of 3 years. Research conducted on 120 patients author of cow's milk
allergy showed mild symptoms when the 90% tolerance will be over the age of one year. In
severe disturbances, accompanied by skin disorders and lead to cough and colds usually be
tolerant to cow's milk over the age of 2-5 years.
 DIAGNOSIS OF COW MILK ALLERGIES

Diagnosis of cow's milk allergy is a clinical diagnosis of a careful anamnesis, observing

signs of atopic on physical examination, examination of total and specific immunoglobulin E to
cow's milk. To ensure a cow's milk allergy should use a blind food provocation (Double Blind
Placebo Control Food Chalenge = DBPCFC). DBPCFC is the gold standard or gold standard.
DBPCFC method, however is very complicated and requires time, is impractical and cost is not
small. Some allergic child care center to modify the way it was. Allergy Center Children's
Hospital Mother of Jakarta to modify a manner that is simple, cheap and quite effective.
DBPCFC modification by doing "Open Food Simplified Elimination Provocation."

Anamnesis or know the history of the term of the symptoms seen the emergence of
symptoms after drinking cow's milk or foods containing cow's milk. Must be known to other
feeding history, including maternal diet during breastfeeding and other feeding companion. Must
also known allergy symptoms of asthma, allergic rhinitis, atopic dermatitis, urticaria, food
allergies, and allergy medicine on the family (parents, siblings, grandparents from parents), and
patients themselves.

Clinical symptoms of the skin such as urticaria, atopic dermatitis, race. Respiratory tract:
recurrent cough especially at night, after exercise asthma, allergic rhinitis. Gastrointestinal
disturbances, vomiting, diarrhea, colic and obstipasi.

Physical examination that may be obtained there hádala skin looks dry skin, urticaria,
atopic dermatitis, allergic Shiner's, Siemen grease, geographic tongue, nasal mucosa, pallor, and
wheezing (wheezing).
 PITFALL DIAGNOSIS AND TREATMENT

Pitfall in the early determination of the diagnosis was only based on laboratory data either
skin test or specific IgE to cow's milk. Whereas the gold standard of diagnosis is by using a blind
food provocation (Double Blind Placebo Control Food Chalenge = DBPCFC). The research
revealed that 25 children a writer with the results of specific IgE to cow's milk is positive,
apparently after an open provocation elimisasi approximately 48% may be intolerant to cow's
milk "nutrient dense", 40% intolerant to cow's milk evaporation, 24% intolerant of milk formula
ordinary cow.

Pitfall diagnosis often occurs only on anamnesis without investigation and DBPCFC. If
not careful anamnesis frequent mistakes due to factors that affect not only the symptoms of cow's
milk proteins. Intersections reactions can also occur due to some additional content in the
formula, and the reaction caused by maternal diet during breastfeeding. Another factor is the
factor triggering the onset of symptoms of infection in children. When an infection such as
cough, cold or heat often trigger allergy symptoms. For example during acute respiratory tract
infections in patients with allergy symptoms are often accompanied by diarrhea, vomiting and
dermatitis.

Too soon to ensure a child was allergic to cow's milk is usually based ketidakcermatan in
analyzing health problems in patients. In determining whether a child suspected allergy to cow's
milk is necessary accuracy and precision. When children drink PASI (Substitute Mother's Milk)
and ASI (Mother's Milk), must be careful in determining the cause of the disturbance. In such
cases, PASI or breast milk can be suspected as the cause of allergies. In breastfeeding mothers
eat a diet that can affect the baby. When granting PASI already lasted more than 1-2 weeks there
is no interference, the possibility of cow's milk formula is not as allergens. It should be noted
whether the mother's diet as a cause of allergy.
 Sometimes there are some children with cow's milk formula which one does not fit but the
other cow's milk formula can be accepted. This is what shows that the composition and other
content in milk formula, which took considerable. Factors that influence might be due to
differences in the process of making the basic ingredients of cow's milk. With heating and certain
processes that are different some specific proteins that interfere will disappear.

Most cow's milk allergy in infants is a fast type of diperan by IgE and the main symptoms
are skin race, Perioral erythema, angioedema, urticaria and anaphylaxis. Conversely, if slowly on
gastrointestinal symptoms such as vomiting, constipation and diarrhea and dermatitis, skin
disorder usually not diperani herpertiformis by IgE. The Role of Non-IgE is usually caused not
by the protein content of cow's milk .. Considering the various types of protein content in cow's
milk and some additional substances such as AA, DHA, the source components of fat (safflower
oil, palm oil, corn oil, soybean oil) or the aroma of flavors (chocolate, honey and strawberries).
Each content has a different potential to cause allergies or reactions from the intersection formula
..

The content of DHA in infant formula can sometimes lead to certain disorders in children
such as skin disorders. While palm oil content can cause gastrointestinal disturbances such as
constipation. Aroma taste like chocolate milk often causes a cough or kosntipasi reaction. So do
certain fat content, corn oil and lactose in the milk formula may cause manifestations similar to
cow's milk allergy. When the disturbance caused by a mild formula is only possible replacement
of cow milk formula without DHA or a specific formula to cow's milk can be reduced
grievances. So if there are complaints regarding the use of cow's milk formula does not
necessarily have to be replaced with soya milk or milk hydrolyzate. But if the complaint is
serious enough to cow's milk replacement formula may need to be considered for the provision
of milk or soy protein hydrolyzate.
 Infant or child who previously had consumed one type of milk cows and do
not experience more complaints within two weeks. Usually after that will not
experience the same milk allergy in the future. It is often misconstrued mean when
a child develops symptoms of allergy, then the milk is replaced. Whereas a few
months before the child has consumed milk that replaced it without complaint.
Often occurs when there are disruptions of other factors. History of other food or an
infection that diderta children when it may cause the same symptoms. Cases such
as these suggest that we should be careful and precise in suspecting whether a
child is allergic to cow's milk or not.

Pitfal handling which often occurs is when the allergy symptoms occur,
patients most often recommended by clinicians is the partial hydrolysis of milk.
Relkomendasi fact that should be given is extensive hydrolyzate infant formula or
soy milk, giving only partial hydrolysis is clinically used for prevention of allergy
sufferers who are at risk for allergy symptoms yet. Nevertheless, in some cases mild
allergic symptoms was granting partial hydrolysis of milk could be beneficial.

Anti-allergy drug administration either peroral or topical is not the best

solution for long-term treatment. Providing long-term anti-allergy is evidence of
failure in identifying the cause of allergies.

CHOICE OF MILK AND FOOD FOR PATIENTS

Feeding is a separate problem in patients allergic to cow's milk. To determine the cow's
milk allergy sufferers main options are extensive milk hydrolyzate. But some patients can also be
intolerant of soya milk. Some babies with mild allergic symptoms can be partially consumed
milk hodrolisat. Although actual milk for allergy prevention rather than for treatment.

Clinical and laboratory are often difficult to ensure that children suffering from cow's
milk allergy. Not easy to determine the selection of the best milk for the child. Often difficult to
ascertain whether a person or intolerance to cow's milk allergy or react to certain content from
existing content in the formula. In a case like this clinic Allergy Center Children's Hospital
Mother Jakarta perform simple elimination of open provocation. In the beginning patients are
given extensive milk hydrolyzate. When allergy symptoms improved formula is then performed
consecutive provocations are more risky, such as soya, partial hydrolyzate, and the minimum
content of infant formula that AA, DHA, palm oil and so forth. The most precise formula is not
as annoying. If symptoms develop in one of these formulas we must select a formula one level
above it safer. When the partial hydrolysis of milk and soya conducted disturbances arising
provocation against lactose milk and a weak single chain (Monochain Trigliceride / MCT).

Many doubts about the nutritional quality of dairy cow milk replacer. Doubts such as
"soy is not fattening," "hypoallergenic milk is not mebuat smart kids because they do not
mengadung DHA" and so forth. Generally, all outstanding formula formally the same nutritional
content. Because it follows the standard RDA (Recomendation Dietery Allowence) in the
amount of calories, vitamins and minerals must be in accordance with the needs of infants to
achieve optimal growth and development. Doubt that a certain formula is not unreasonable
because the content of fattening calories, vitamins and minerals is no different. Use any brand of
milk formula suitable for the condition and age of the child does not cause disruption of bodily
functions is the best milk for the child. If discrepancies continue to be forced to cow's milk
delivered, will disturb body function particularly gastrointestinal disorder that makes children's
growth and development .

British Nutrition Foundation, ESPGAN (European Society for Pediatric Gastroenterology

and Nutrition), WHO (World Health Organization) and FAO (Food Agriculture Organization)
recommends the addition of DHA and AA need only to preterm infant formula. In theoretical
and clinical evidence is only useful additions for premature babies, because it has not been able
to synthesize AA and DHA are good. Addition of AA and DHA directly does not really matter
because the body newborns can already produce their own mensitesa or AA and DHA from
another fatty acid esessial.

Several alternative options to replace cow's milk varies greatly depending on the
condition of each child. These include breast milk substitutes, soy milk, milk kambingI,
extensive hydrolysis of milk, milk partial hydrolyzate, sintesi amino acids and so forth.
 Mother's Milk

Breastfeeding is the best option for infants with cow's milk allergy. Breastfeeding has
been clinically proven to prevent the incidence of allergies later in life. Meskpiun can prevent
allergies, but apparently the mother consumed a diet can also lead to allergies in infants. So that
mothers should also make certain that elimination diets can interfere with the baby. Mothers
must avoid various types of cow's milk or food containing cow's milk.

Soya Milk

Soya formula milk is one of formula milk substitutes for infants and children who have
allergies to cow's milk protein. Soya milk is also lactose-free formula that safely used by infants
and children who need a lactose-free diet. Soya using soy protein isolate as a feedstock. Soy
protein isolate has a high protein content which is equivalent to cow's milk. Just as in human
milk, calcium and phosphorus in soya milk has a ratio of two formulas: one to support the
formation of strong bones and teeth. This formula also contains essential fatty acids, namely
Omega 6 and Omega 3 with an appropriate ratio as a base for the formation of AA and DHA for
optimal brain growth and development.

Carbohydrates in soy formula is Maltodextrine, which is a type of carbohydrate that can

be tolerated by the digestive system of infants who were injured while experiencing diarrhea or
by the digestive system of babies who are allergic to cow's milk. Soy formula (soy)
approximately the same nutritional benefits compared to the extensive hydrolyzate formula, but
it's cheaper and more familiar.

In a study of 170 infants allergic to cow's milk soya milk was found acceptable by the
majority of infants with cow's milk allergy both IgE and non IgE. The development of IgE
associated with soya milk includes rare. Soya milk alternatives recommended for p; ertama in
patients allergic to cow's milk at the age of 6 months. But not that research is changing the soy
formula feeding under the age of six months. Children who have allergies to cow's milk, it got
about 30-40% soy milk allergy.

Goat Milk

In some countries traditionally goat's milk is often given to patients allergic to cow's
milk. Goat's milk is not a complete nutritional milk for the baby .. Very small content of certain
vitamins, like folic acid, vitamin B6, B12, C, and D, but rich in minerals. Goat's milk and cow
milk have identical epitopes as the allergen material. So the goat's milk is usually not tolerated
well by patients allergic to cow's milk.

Extensive hydrolysis of milk formula

Alternative to cow's milk allergy is a milk formula containing cow milk protein
hydrolysis (through special processing). This formula did not taste so good and relatively more
expensive .. Whey protein is often much easier in the denaturation (destroyed) by the heat than
the casein proteins are more resistant to heat. So that the process of denaturation of whey can be
accepted by patients allergic to cow's milk, like cow's milk evaporation.

European Society of Paediatric Allergy and Clinical Immunology (ESPACI) defines the
formula is a formula that extensive hydrolysis of protein hydrolysis with base material with
fragments that are small enough to prevent allergies in children. Formula extensive hydrolysis
would meet clinical criteria for clinically acceptable when 90% of patients with proven IgE-
mediated allergy to cow's milk (95% confidence intervals) as recommended by the American
Academy of Paediatrics Nutritional Committee. So far approximately 10% of patients allergic to
cow's milk can cause a reaction to extensive hydrolysis of milk formula. In certain patients who
are allergic to extensive hydrolysis formula is unknown, estimated at more than 19%. Experience
the use of casein hydrolysis was done almost 50 years, some research indicates very effective for
patients allergic to cow's milk. Hydrolysis of milk casein contained in the market is Nutramigen
(Mead Johnson) and Pregestimil (Mead Johnson). While the hydrolysis of whey in the last time
this started to be an alternative, and clinical tolerance seems similar to casein hydrolysis. Some
examples of hydrolysis of milk whey is Aalfa-Re (Nestle) and Pepti-Junior (Nutricia). Whey
protein is more easily denatured by heat but the temperature is extremely heat resistant casein .

Partial hydrolysis Formula

Partial hydrolysis of milk formulas containing peptides still large enough to still
have a potential to cause allergic reactions sapi.Susu milk is not recommended for
pengiobatan or substitute milk for cow's milk alergu patients.

Low-allergy or hypoallergenic milk is an example Enfa NAN HA and HA. Milk

is recommended for allergy sufferers at high risk before the show the existence of allergy
symptoms. Research indicates provision of partial hydrolysis Formula reduces onset of
allergic symptoms that can be generated.

Synthetic amino acid formula

Neocate is 100% synthetic amino acid which is the basic ingredient

hypoallergenic formula milk. Sense of this formula is relatively more comfortable and
more able to taste more acceptable to the baby in general, but very expensive.

Neocate is used to overcome the symptoms of food allergies and severe

persistent. Like Multiple Food Protein intolerance, alergy to extensively hydrolysed
formulae, food allergies with increasing body weight disorders, allergic colitis, GERD
who did not respond to standard therapy. Multiple food protein intolerance or intolerance
MFPI defined as more than 5 main meals including EHF (Hydrolysa extensive Milk) and
soya milk formula. MFPA (Multiple food protein allergy) is defined as more than one
food allergy essentials like milk, flour, eggs and soy. Milk is also used as a placebo in a
DBPCFC to diagnose cow's milk allergy

Feeding
 Cow's milk allergy sufferers should also avoid foods containing raw materials
such as skim milk, dried milk or milk evaporation condensation. Lactaid, which is
processed dairy products specifically for those who experience lactose intolerance
disorders. Lactaid allegedly still contains cow's milk protein, so it should not be given to
children who suffer from allergies. Butter or butter milk, soy products that contain cow's
milk, food products containing casein, caseinates, sodium or calcium caseinates,
lactalbumin, and wheyArtificial butter, Butter, Buttermilk, Casein, Cheese, Cream,
Cottage cheese, yogurt, Casein hydrolyzate , Milk goats, Laktalbumin, Laktglobulin,
Lactose, lactulose, Sour Cream, Whey.

Cow's milk allergy sufferers often also have other food allergies. Foods to
watch out for is eggs, certain fruits, nuts and fish. Patients are rarely allergic to cow's
milk are also allergic to beef. Many sufferers are allergic to cow's milk can consume
without experiencing any symptoms of beef allergy.

PREVENTION OF COW MILK ALLERGIES

Prevention of allergy to cow's milk should be done early. This happened just
before arising sensitization to cow's milk proteins, namely since intrauterine. Avoidance
must be made with hypoallergenic cow's milk that is partially hydrolyzed cow's milk for
cow's milk stimulates the emergence of tolerance in the future. When it happens to cow's
milk protein sensitization or allergic disease manifestations have occurred, it must be
perfect hydrolyzed cow's milk or cow's milk substitutes such as soy bean milk.

Cow's milk allergy that often arise could facilitate the occurrence of other food
allergies later in life when it happens persistent gastrointestinal damage. Prevention and
treatment of good and sustained very necessary to prevent food allergies later on .. ask
more precautions to cow's milk allergy are also almost the same as you would on any
other allergies. Generally, cow's milk allergy preventive measures carried out in three
phases, namely:
 Primary prevention

Conducted before the sensitization. When done since prenatal avoidance of the
fetus from atopic families who have talent. Avoidance of cow's milk hypoallergenic form
of cow's milk, cow's milk which is partially hydrolyzed, in order to stimulate the
emergence of tolerance to cow's milk at a later date because masihmengandung little
particles of cow's milk, for example by stimulating the emergence of IgG blocking agent.
This precaution is also made to other food allergens and avoidance of cigarette smoke.
Nevertheless AAAI only recommend avoidance [of nuts during pregnancy.

Secondary Prevention

Performed after sensitization but not allergic disease manifestations arise. State of
sensitization determined by examination of specific IgE in serum or blood talipusat, or
with the skin test. When the optimal action is age 0 to 3 years. Avoidance of cow's milk
to cow's milk by giving non alergenik, which is perfect hydrolyzed cow's milk or cow's
milk substitutes such as soy milk that does not occur until further sensitization occurs
manifestations of allergic diseases .

Exclusive breastfeeding appears to reduce the risk of allergies, but be aware of

maternal diet during lactation was also accompanied by other measures such as provision
of immunomodulatory, Th1-immunoajuvants, probiotics. This action aims at reducing the
dominance of Th2 lymphocytes, is expected to occur within six months.

Tertiary Prevention

Performed on children who have experienced the manifestation of sensitization

and showed an early allergic diseases such as atopic dermatitis or rhinitis, but have not
indicated a more severe allergy symptoms such as asthma. When the optimal action is at
the age of 6 months to 4 years.
 Avoidance also by providing a perfect hydrolyzed cow's milk or cow's milk
substitutes. Provision of preventive medicine such as setirizin, imunoterapi,
immunomodulatory not recommended because it has not been proven clinically useful.
Contribute a better translation

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