Milk Allergy

"Milk allergy" is an erroneous but often used designation in the population for one of the following diagnoses:

• Allergy on cow milk protein;
• Lactose intolerance

	Allergy on cow milk protein;	Lactose intolerance
Problem	an immunological reaction to any of the cows' milk proteins	impaired ability to break down lactose ("milk sugar")
Manifestations	gastrointestinal, cutaneous, respiratory, anaphylactic reaction, behavioral disorders	osmotic diarrhea, malabsorption
Diagnostics	elimination-exposure test	stool examination, hydrogen respiratory test, molecular genetic examination
Treatment	complete exclusion of cow's milk from the diet	lactose-free diet, or lactase supplementation

Allergy/Hypersensitivity on cow milk protein

• an immunological response to any of the cows' milk proteins;
  • in addition to IgE-mediated reactions, other types of allergic reactions are involved;
• it usually occurs in infancy;

First definition of ecotoxicology (1969): René Truhaut: the study of the adverse effects of chemicals with the aim of protecting natural species and communities. Rachel Carson (1962): the memoir The Silent Spring highlights the use of pesticides , especially DDT and other agrochemicals. The book led to the establishment of the US Environmental Protection Agency (EPA) in the USA. Introduction of methods describing the toxic effects of human-produced substances on the environment and the organisms contained therein. Systematic implementation of fish toxicity testing methods. In addition to direct toxic effects, the effects of bioconcentration and bioaccumulation are studied – increases in the concentration of foreign substances in the tissues of organisms as a result of exposure from the environment.

2004 EC ratification: Persistent Organic Pollutants Protocol to the 1979 Convention on Long-Range Transboundary Air Pollution The aim of the protocol is to limit, reduce or eliminate the discharge, emissions and losses of persistent organic pollutants that have significant adverse effects on human health or the environment due to long-range transboundary air transport.

In 2006 , Regulation No. 166/2006 of the European Parliament and the EC Council was issued, establishing the European Register of Releases and Transfers of Pollutants . It represents a publicly accessible database of pollutant releases into the air, water and soil, information on wastewater, information on pollutant releases from dispersed sources.

In 2003 , the proposal for a new framework for legislation covering the safety of chemicals REACH (Registration, Evaluation and Authorization of Chemicals) was accepted by the European Commission and approved by the European Parliament . Enterprises and firms that import more than 1 ton of a chemical compound per year will be forced to register this chemical in a central data bank. The aim is to improve the protection of the health of nature, including people, to increase the innovation capacity and the ability of the chemical industry to compete in the European Union. The new measures concern not only new chemical substances introduced to the market, but also substances that have been used for a long time. The program aims to ensure that by 2020 at the latest, only chemical substances with known properties and in a way that does not harm human health and the environment are used.

• manifests itself in gastrointestinal (approximately 60% of affected), cutaneous (50-60%) and respiratory symptoms (approximately 1/3), these symptoms are often combined;
  • gastrointestinal symptoms: zvomiting, diarrhea, malabsorption, gastroesophageal reflux, enterorrhea, constipation;
  • cutaneous manifestations: oral allergic syndrome, rash, urticaria, angioedema, eczema;
  • respiratory manifestations: runny nose, expiratory dyspnoea, cough;
  • anaphylactic reaction: drop in blood pressure, shock;
  • behavioral disorders: irritability, abdominal colic;
• it's unlikely to take place if the baby tolerates full portions of cow's milk for more than 3 months;
• diagnostics: elimination-exposure test - elimination of cow's milk from the diet and subsequent re-exposure to confirm the allergic nature of the reaction;
  • in the case of eosinophilic and non-IgE reactions, elimination must last at least 2 weeks, in the case of atopic dermatitis and allergic colitis 4 weeks;
  • skin prick tests and determination of the level of specific IgE against cow's milk have low sensitivity and specificity, they do not show a non-IgE reaction, they can also be false positive;
• treatment: complete elimination of cow's milk from nutrition (extensively hydrolyzed formulas, possibly mixtures of amino acids), in breastfed children it is necessary to eliminate cow's milk proteins from the mother's diet and at the same time supplementation (mother) with calcium (1 g / day);

First definition of ecotoxicology (1969): René Truhaut: the study of the adverse effects of chemicals with the aim of protecting natural species and communities. Rachel Carson (1962): the memoir The Silent Spring highlights the use of pesticides , especially DDT and other agrochemicals. The book led to the establishment of the US Environmental Protection Agency (EPA) in the USA. Introduction of methods describing the toxic effects of human-produced substances on the environment and the organisms contained therein. Systematic implementation of fish toxicity testing methods. In addition to direct toxic effects, the effects of bioconcentration and bioaccumulation are studied – increases in the concentration of foreign substances in the tissues of organisms as a result of exposure from the environment.

2004 EC ratification: Persistent Organic Pollutants Protocol to the 1979 Convention on Long-Range Transboundary Air Pollution The aim of the protocol is to limit, reduce or eliminate the discharge, emissions and losses of persistent organic pollutants that have significant adverse effects on human health or the environment due to long-range transboundary air transport.

In 2006 , Regulation No. 166/2006 of the European Parliament and the EC Council was issued, establishing the European Register of Releases and Transfers of Pollutants . It represents a publicly accessible database of pollutant releases into the air, water and soil, information on wastewater, information on pollutant releases from dispersed sources.

In 2003 , the proposal for a new framework for legislation covering the safety of chemicals REACH (Registration, Evaluation and Authorization of Chemicals) was accepted by the European Commission and approved by the European Parliament . Enterprises and firms that import more than 1 ton of a chemical compound per year will be forced to register this chemical in a central data bank. The aim is to improve the protection of the health of nature, including people, to increase the innovation capacity and the ability of the chemical industry to compete in the European Union. The new measures concern not only new chemical substances introduced to the market, but also substances that have been used for a long time. The program aims to ensure that by 2020 at the latest, only chemical substances with known properties and in a way that does not harm human health and the environment are used.

• prognosis: cow's milk tolerance is gradually improving.

Iron

Lactose intolerance/malabsorption

• impaired ability to break down lactose ('milk sugar');
• lactose is a disaccharide that is broken down in the small intestine by lactase to glucose and galactose, and these are absorbed into the blood;
• lactase is one of the brush border enzymes of enterocytes; a distinction is made between primary (congenital) lactase deficiency and secondary deficiency accompanying severe intestinal mucosal damage; undigested lactose travels to the large intestine, where it is fermented by bacteria to form hydrogen, methane, carbon dioxide, lactate and short-chain fatty acids;
• the result is malabsorption and osmotic diarrhea;
• manifests itself in abdominal pain, flatulence, diarrhea, nausea and vomiting;
• diagnosis: anamnesis, stool examination (pH <5, reducing substance> 0.5%), positive hydrogen breath test after oral administration of lactose, disappearance of symptoms after exclusion of lactose from the diet;
• treatment: lactose-free diet, preparations with lactase can be added to dairy products, with limited intake of dairy products it is necessary to supplement calcium.

Secondary lactose intolerance/malabsorption

• reduced ability to tolerate the disaccharide lactose ("milk sugar");
• may occur temporarily after acute diarrheal disease - the decrease in intestinal lactase activity is proportional to the degree of damage to the intestinal mucosa;
• accompanies diseases associated with atrophy of the villi of the small intestinal mucosa, such as:

• in differential diagnosis it is always necessary to exclude celiac disease by serological examination;
• lactose intolerance is indicated by the presence of more than 0.5% reducing carbohydrates in the faeces and a faecal pH lower than 5.0;
• treatment: temporary exclusion of lactose from the diet.

Primary lactose intolerance/malabsorption

Congenital (primary) deficit of lactose

• very rare
• manifests itself in diarrhea from the moment the baby is given milk, including breast milk;
• the stool is watery, foamy and acidic;
• identification: molecular-genetic examination;
• treatment: dietary measures - lactose-free milk, preparations containing lactase.

Lactose malabsorption with late lactose deficit -adult hypolactasy

• autosomal recessively inherited; corresponds to the physiological process of declining enzyme activity that begins after weaning and manifests itself at any time from childhood to adulthood;
• diagnostics: molecular-genetic examination, or intestinal biopsy;

First definition of ecotoxicology (1969): René Truhaut: the study of the adverse effects of chemicals with the aim of protecting natural species and communities. Rachel Carson (1962): the memoir The Silent Spring highlights the use of pesticides , especially DDT and other agrochemicals. The book led to the establishment of the US Environmental Protection Agency (EPA) in the USA. Introduction of methods describing the toxic effects of human-produced substances on the environment and the organisms contained therein. Systematic implementation of fish toxicity testing methods. In addition to direct toxic effects, the effects of bioconcentration and bioaccumulation are studied – increases in the concentration of foreign substances in the tissues of organisms as a result of exposure from the environment.

2004 EC ratification: Persistent Organic Pollutants Protocol to the 1979 Convention on Long-Range Transboundary Air Pollution The aim of the protocol is to limit, reduce or eliminate the discharge, emissions and losses of persistent organic pollutants that have significant adverse effects on human health or the environment due to long-range transboundary air transport.

In 2006 , Regulation No. 166/2006 of the European Parliament and the EC Council was issued, establishing the European Register of Releases and Transfers of Pollutants . It represents a publicly accessible database of pollutant releases into the air, water and soil, information on wastewater, information on pollutant releases from dispersed sources.

In 2003 , the proposal for a new framework for legislation covering the safety of chemicals REACH (Registration, Evaluation and Authorization of Chemicals) was accepted by the European Commission and approved by the European Parliament . Enterprises and firms that import more than 1 ton of a chemical compound per year will be forced to register this chemical in a central data bank. The aim is to improve the protection of the health of nature, including people, to increase the innovation capacity and the ability of the chemical industry to compete in the European Union. The new measures concern not only new chemical substances introduced to the market, but also substances that have been used for a long time. The program aims to ensure that by 2020 at the latest, only chemical substances with known properties and in a way that does not harm human health and the environment are used.

Transient lactase deficiency in premature infants

• in premature infants, relatively low lactase activity persists until the 36th gestational week.

Iron

References

Following articles

• Intolerance jídla • Potravinová alergie

Kategorie: Gastroenterologie Kategorie:Imunologie