By: Dr Widodo Judarwanto SpA,

Upik 9-month-old had just been convicted of cow’s milk allergy by a doctor. His parents could wonder, why since birth been drinking cow’s milk is never a problem. The mother got worried because a lot of information circulating that when drinking soy milk and hypoallergenic milk is not intelligent and can not be fat. Is it true that babies who previously did not have cow’s milk allergy then be changed? Is it true that drinking soy milk or hypoallergenic be not intelligent and can not be fat?

Cow’s milk is considered as a cause of food allergies in children who most often and most common early in life. Cow’s milk allergy is a disease based on immunological reactions that arise as a result of the cow giving milk or foods containing cow’s milk. Cow’s milk allergy is a collection of symptoms that many organs and body systems caused by allergy to cow’s milk.

Detection and prevention of cow’s milk allergy should be done carefully early on. Pitfall diagnosis of cow’s milk allergy because the symptoms often experienced symptoms similar to cross reactions to cow’s milk formula components and the influence of maternal diet during breastfeeding.

Hippocrates first reported the reaction to cow’s milk around the year 370 AD. 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 allergies 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 are generally allergic to proteins found in cow’s milk. While approximately 80% of infant formula on the market was using the basic ingredients of cow’s milk.

Cow’s milk allergy is a collection of symptoms that many organs and body systems caused by allergy to cow’s milk with the involvement of the immune system mechanisms. Reaction mechanism is basically milk that type I hypersensitivity reactions and hypersensitivity to food that is essentially a hypersensitivity reaction type III and IV. Cross reaction of food that does not involve the immune system mechanisms known as milk intolerance .. Allergic to cow’s milk protein or an allergy to formula containing cow’s milk protein is a situation where someone has a system of immune reaction against the abnormal protein found in cow’s milk. Baby’s immune system will fight the protein contained in cow’s milk so that the symptoms of an allergic reaction will appear.

Cow’s milk allergy will be 80% 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 it happen tolerance to cow’s milk. The contrast between cow’s milk allergic disease and other food allergies in infants is that tolerance can occur spontaneously during early childhood.

Avoidance of cow’s milk should be done until there is tolerance of about 2-3 years of age and should be given soy milk formula or substitute for cow’s milk and hidrolisat perfect solids-free cow’s milk and cow’s milk products. Prevention of allergy should be done as early as possible at-risk atopic children, research shows that 85% of ASS will be tolerated before the 3-year-old child. Although tolerance would occur at that age, preventive measures and proper governance necessary to prevent a more severe allergies and food allergies other allergens later in life.

Allergy is an important issue which should not be underestimated. Posed reaction may disrupt the body’s organs and behavior of children. That can interfere with 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 to easily sensitized atopic and develop into allergic disease specific allergens such as food and inhalan.

EVENT MECHANISM DISORDERS

Cow’s milk allergy occurs because the specific defense mechanisms and non-specific gastrointestinal baby is not perfect. Cow’s milk is the main foreign protein given to an infant, to distinguish between an allergic reaction to cow’s milk and immunological intolerance reactions are not based on immunological disorders such as toxic effects of bacterial stafilokok, metabolic defects due to lack of the enzyme lactase, idiosinkrasi reaction or cross reaction of the material Other materials contained in the formula.

Cow’s milk protein is the most common allergens in a variety of hypersensitivity reactions in children. Cow’s milk contains at least 20 component proteins that could interfere with the aberrant immune response to someone .. Cow’s milk protein casein and is divided into whey. Casein is a milk-shaped section is usually found in thick consisting of 76-86% of cow’s milk proteins. Casein can in precipitation with acid at pH 4.6. Whey comprises 20% of total milk protein, consisting of about β-lactoglobulin (9% 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 routine pasteurization is not sufficient to eliminate these proteins but instead enhance the nature alergenitas some milk proteins such as b-laktoglobulin.

Many studies of cow’s milk protein alergenitas. There are more than 40 different types of protein in cow’s milk that has the potential to cause sensitivity. Content of cow’s milk is the most common cause is allergic lactoglobulin, casein further, lactalbumin bovine serum albumin (BSA). Immunoelectrophoretic analysis showed that casein reduced alergenisitasnya after heating around 120 C for 15 minutes, while lactoglobulin, lactalbumin decreases the warming of more than 100C. BSA and gammaglobulin lost antigenisitasnya at temperatures between 70C. 80C.

Full warming will occur denaturation of some whey proteins. β. lactoglobulin is the most powerful cause of allergens. Another study mentioned 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 are the most allergens. Recent research mentioned casein-specific IgE obtained 100% in the group allergic, IgE from β. Lactoglobulin about 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 of allergic reactions to cow’s milk is the skin, gastrointestinal tract and respiratory tract. Reaction acute (short term) more often than itching and anaphylaxis. While the reaction of chronic (long term) which occurs is astma, dermatitis (eczema skin) and gastrointestinal disorders. Some manifestations of cross reactions due to cow’s milk through the mechanism of IgE and non IgE.

Target organs are often affected are the skin form of urticaria and angioedema. Gastrointestinal system is disrupted oral allergy syndrome, gastrointestinal Anaphylaxis, allergic eosinophilic gastroenteritis. Airway is happening is asthma, colds, chronic coughing repeatedly. Target multiorgan of anaphylaxis due to food or anaphylaxis was triggered because the activities associated with food

In addition to the target organ is often the case mentioned above, manifetasi other clinical manifestations of unusual (anussual Manifestation). Among them are the skin manifestations of vasculitis, fixed Skin Eruption. Gastrointestinal system is affected Pulmonary chronic disease (Heiner syndrome), hypersensitivity pneumonitis. Gastrointestinal tract that occur are constipation, gastroesophageal refluk, such as hypersecretion of airway bronchi (breathing sounds of grunt-grunt) and nasolakrimalis duct obstruction (often watery eyes and belekan) multiorgan Target of irritability / Sleeplessness in Infants, artropati, nephropathy and thrombocytopenia

Reaction to cow’s milk that can result from 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 3 patterns of clinical response to milk protein allergy in children: Rapid Response, the time from after drinking milk until onset of symptoms. The reaction was (digestion), 45 minutes to 20 hours. While Slow reaction (skin and sal.cerna), more than 20 hours. Initial reaction in the skin, symptoms begin 45 minutes after consuming milk. The reaction may be red spots (like measles) or itching. Other symptoms of respiratory system disorders such as breath sounds. Ngik. (wheezing), or rhinoconjuncy = tivitis (sneezing, itchy nose and eyes, and red eyes). Symptoms such bias occurs even if only a little cow’s milk consumption. Hill et al have reported that nearly all (92% of patients in this group in the examination of 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’s reaction to the symptoms that often occur are vomiting, diarrhea began after 45 minutes to 20 hours after getting exposure to milk. According to research about a third of this group obtained positive results of skin tests (skin prick test).

Symptoms that arise in the slow reaction occurs in about 20 hours after exposure to infected cattle susus. For this reaction required amount of cow’s milk volume is large enough. In this group only about 20% of obtained results of positive skin test. Allergic temple Test (Patch Test) is conducted for 48 hours there is often a positive outcome in this group. Most occurred in the age of 6 months. Signs and symptoms that often occur are diarrhea, constipation (hard money big water) and dermatitis (skin disorder)

COW MILK ALLERGIES DIAGNOSIS

Diagnosis of cow’s milk allergy is a clinical diagnosis of a careful anamnesis, observing signs of atopy physical examination, examination of total immunoglobulin E and specific cow’s milk. To ensure the 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. But how DBPCFC is very complex and takes time, is impractical and not cost less. Some allergic child care centers modify the way it was. Allergy Center Children’s Hospital Mother Jakarta making modifications in a more simple, cheap and quite effective. DBPCFC modification by doing. Elimination Provocation Simple Food Open ..

Anamnesis or know the history of symptoms seen a period of onset of symptoms after drinking cow’s milk or foods containing cow’s milk. Must be known to other feeding history, including maternal diet during breast-feeding and other feeding companion. Must be known also allergic asthma symptoms, allergic rhinitis, atopic dermatitis, hives, food allergies, and allergy medicine on the family (parents, brother, grandfather, grandmother of parents), and patients themselves.

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

Physical examination may be obtained there hadala skin looks dry skin, hives, atopic dermatitis allergic shiner.s, Siemen grease, geographic tongue, pale nasal mucosa, and wheezing (wheezing).

PITFALL DIAGNOSIS AND HANDLING

Or Pitfall. Mistakes which plunged. occurred in the early determination of the diagnosis made only on the basis of laboratory data either skin test or specific IgE to cow’s milk. Whereas the gold standard diagnosis is to use a blind food provocation (Double Blind Placebo Control Food Chalenge = DBPCFC). Authors conducted research revealed that 25 children with specific IgE results of the positive cow’s milk, it turns out after the open provocation elimisasi about 48% may be intolerant to cow’s milk. Nutrient dense., 40% intolerant to cow’s milk evaporation, 24% intolerant to formula normal cows.

Pitfall diagnosis often occurs only on the basis anamnesa without investigation and DBPCFC. If not careful anamnesis frequent mistake because factors that affect the symptoms arising not only cow’s milk protein. Cross reactions which occur can also be caused by some additional content in infant formula and reaction caused because the diet during breastfeeding mothers. Other factors that trigger the onset of symptoms is a factor of infection in children. When an infection such as cough, cold or heat often trigger allergy symptoms. For example during acute respiratory infections in patients allergic 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 people. In determining whether a child has an allergy to cow’s milk is needed accuracy and precision. When children drink pale (Milk Substitute Mother) and ASI (Air Susu Ibu), must be careful in determining the cause of these disorders. In such cases, white or milk may be suspected as the cause of allergies. In breastfeeding, eat a diet that can affect the baby’s mother. When providing previously Pasi lasted more than 1. 2 weeks there is no interference, the possibility of cow’s milk formula is not as a cause of allergy. It should be noted whether the mother’s diet as a cause of allergy.

Sometimes there are some children with cow’s milk formula that one does not fit but the other cow’s milk formula can be accepted. This is what shows that the composition and other ingredients in these formulas involved role. Factors that might influence because of differences in the basic materials pembutan process cow’s milk. With heating and different specific processes some specific proteins will disappear.

Most cow’s milk allergy in infants is a type of rapid diperan by IgE and the main symptoms are skin race, Perioral erythema, angioedema, hives and anaphylaxis. Whereas if the symptoms of gastrointestinal slow form of vomiting, constipation and diarrhea and skin disorders are usually not herpertiformis dermatitis diperani by IgE. Role of Non-IgE is usually caused not by the protein content of cow’s milk .. Seeing different types of protein content in cow’s milk and some additives such as AA, DHA, a source of fat component (safflower oil, palm oil, corn oil, soybean oil) or aroma taste (chocolate, honey and strawberry). Each compound has a different potential to cause allergies or cross reactions of the infant formula ..

Content of DHA in infant formula can sometimes cause interference on a particular child of skin disorders. Meanwhile, palm oil content can cause gastrointestinal disturbances in the form of constipation. The smell taste like chocolate milk often causes coughing or kosntipasi reaction. So do certain fat, corn oil and lactose in milk formula may cause manifestations similar to cow’s milk allergy. If the interference is due to infant formula may only mild cow’s milk replacement 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 hidrolisat. But if his complaint might be heavy enough to cow’s milk replacement formula should be considered for granting or hidrolisat soya milk proteins.

Infant or child who previously had consumed one type of cow’s milk and did not experience more complaints within 2 weeks. Usually after that will not experience the same milk allergy in the future. This is often incorrectly interpret as the child develops symptoms of allergy, and milk replaced. Whereas previously the child had several months to consume the milk is replaced without complaint. Often occurs when there is interference factors other causes. Other feeding history or the presence of infection at the time diderta child can cause the same symptoms. This case shows that we must be careful and precise in suspecting whether a child is allergic to cow’s milk or not.

Several studies indicate an allergy to cow’s milk about 80% will disappear or become tolerant before the age of 3 years. Authors conducted research on 120 patients allergic to cow’s milk showed mild symptoms when the tolerant will be over the age of 1 year. If severe disorders, accompanied by skin disorders and cause coughing and colds are usually resistant to cow’s milk over the age of 2 to 5 years.

Pitfal handling is often the case when allergy symptoms occur, patients most often recommended by clinicians is hidrolisa partial feedings. And that should be given relkomendasi is extensive hidrolisat formula or soya milk, granting partial hidrolisa clinically used only for prevention of allergy sufferers who are at risk for allergy symptoms yet. However, in some cases if the experience gained mild allergic symptoms were partially hidrolisa feeding can be useful.

Provision of anti-allergic drugs 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.

GRANTING OF MILK AND FOOD FOR PATIENTS

Giving milk is a separate problem in patients allergic to cow’s milk. To determine the cow’s milk allergy sufferers main choice is extensive hidrolisat milk. But some patients can also intolerant of soya milk. Some babies with mild allergic symptoms can consume milk hodrolisat partial. Although actual milk allergy is to prevent rather than to treatment.

Clinical and laboratory are often difficult to ensure that the child was allergic to cow’s milk. Not easy to determine the selection of the best milk for the child. Often difficult to determine whether a person is allergic or intolerant to cow’s milk or react to certain content from existing content in the formula. In a case like this clinic Allergy Center Children’s Hospital Mother Jakarta do simple elimination of open provocation. In the beginning the patient was given extensive hidrolisat milk. If allergy symptoms improved formula is then performed consecutive provocations are more at risk such as soya, partial hidrolisat, and formula contain a minimum of AA, DHA, palm oil and so on. The most appropriate formula is that not cause interference. If symptoms develop in one of these formulas we have to choose the formula one more level of security on it. When the milk and soya hidrolisa partial disruption arising provocation carried out on milk lactose and weak single chain (Monochain Trigliceride / MCT).

Many doubts about the nutritional quality of cow’s milk substitute milk. Doubt is like. Soya is not fattening.,. Hypoallergenic milk is not good because mebuat children mengadung not DHA. and so on. In general, all formulas which formally circulated the same nutritional content. Because follow standard RDA (Dietery Recomendation Allowence) in the amount of calories, vitamins and minerals must be in accordance with the needs of infants to achieve optimal growth. Doubt that a certain formula is not unreasonable for fattening calories, vitamins and minerals is no different. Any use of formula milk brands that match the condition and age of children does not cause interference for body functions is the best milk for the child. If discrepancies continue to forced cow’s milk feeding, would interfere with body functions, especially gastrointestinal disorders that make 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 addition for premature babies, as they are not able to synthesize AA and DHA as well. Addition of AA and DHA directly is not very important because baby’s body was enough moon was able to produce your own mensitesa or AA and DHA from another fatty acid esessial.

Several alternatives to cow’s milk substitutes vary widely depending on the condition of each child. Milk substitutes include milk, soy milk, milk kambingI, hidrolisa extensive milk, milk partial hidrolisat, sintesi amino acids and so on.

Mothers Milk

Breastfeeding is the best option for infants who have cow’s milk allergy. Breastfeeding is clinically proven to prevent allergic events in the future. Although prevent allergies, but the diet consumed by the mother was also able to cause allergies in her baby. So that the mother should also make certain that elimination diets can interfere with the baby. My mother had to avoid various types of cow’s milk or foods containing cow’s milk.

Soya Milk

Soy formula milk is lactose-free formula milk for infants and children who have allergy to cow’s milk proteins. Nutrilon Soya is lactose-free formula that safely used by infants / children who are suffering from diarrhea or lactose-free diet requires. Soya using soy protein isolates as the basic material. Soy protein isolate has a high protein content which is equivalent to cow’s milk. Just as in human milk, calcium and phosphorus in soy formula has the ratio 2: 1 to support the formation of bones and teeth strong. This formula milk also contains some essential fatty acids, namely Omega 6 and Omega 3 with an appropriate ratio as the base material forming AA & DHA for brain growth is optimal. Provision of AA and DHA directly on these formulas is not very important because baby’s body was enough months have been able to produce your own mensitesa or AA and DHA from another fatty acid esessial contained in the milk content

Carbohydrates in soy formula is maltodextrin, which is a type of carbohydrate that can be tolerated by the digestive system of infants who were injured while experiencing diarrhea or the baby’s digestive system that is allergic to cow’s milk. Soy formula milk (soy) is approximately the same nutritional benefits than formula hidrolisat extensive, but it’s cheaper and more familiar.

In the study conducted on 170 infants allergic to cow’s milk soya milk 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, including rare. Soya milk alternatives recommended for p; ertama in patients allergic to cow’s milk at age over 6 months. But this research does not mean changing soy formula feeding under the age of 6 months. Children who have allergies to cow’s milk, was found about 30. 40% have soya 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 milk with a complete nutrition for babies .. Particular vitamin is very small, such as folic acid, vitamin B6, B12, C, and D, but rich in minerals. Goat’s milk and milk that is identical sapimemiliki epitop as allergen material. So the goat’s milk is usually not well tolerated by patients allergic to cow’s milk.

Formula Extensive Hidrolisa

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

European Society of Pediatric Allergy and Clinical Immunology (ESPACI) defines hidrolisa extensive formula is a formula with ingredients hidrolisa protein fragments small enough to prevent allergies in children. Formula extensive hidrolisa will meet the clinical criteria when clinically acceptable 90% of patients proven IgE-mediated cow’s milk allergy (95% confidence interval) as recommended by the American Academy of Paediatrics Nutritional Committee. So far, about 10% of patients allergic to cow’s milk can cause a reaction to formula hidrolisa extensive. In certain patients who are allergic to the formula unknown hidrolisa extensive, estimated at more than 19%. Experience using casein hidrolisa has done nearly 50 years more, some studies have shown very effective for patients allergic to cow’s milk. Milk casein contained Hidrolisa market is Nutramigen (Mead Johnson) and Pregestimil (Mead Johnson). While whey hidrolisa the last time it started to become an alternative, and tolerance in the clinic seems almost the same as hidrolisa casein. Some examples hidrolisa milk whey is Aalfa-Re (nestle) and Pepti-Junior (Nutricia). Whey protein is more easily denatured by heat, but casein is heat resistant ..

Formula Partial hidrolisa

Hidrolisa partial formula milk still contains large enough so that the peptide still has the potential to cause allergic reactions sapi.Susu milk is not recommended for pengiobatan or substitute milk for cow’s milk alergu patients.

Hypoallergenic or low milk allergy is an example Enfa NAN HA and HA. Milk is recommended for high-risk patients allergic to before showing any symptoms of allergy. Studies show giving Partial Formula hidrolisa reduce the onset of allergy symptoms can be caused.

Synthetic amino acid formula

Neocate is a synthetic amino acid which is 100% raw material 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 the increase in body weight disorders, allergic colitis, GERD who did not respond to standard therapy. Multiple food protein intolerance or MFPI intolerance is defined as more than 5 main meals including EHF (Hydrolysa extensive Milk) and soy formula. MFPA (Multiple food protein allergy) is defined as allergic to more than 1 basic foods such as milk, flour, eggs and soybeans. 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 that contain ingredients such as skim milk, dried milk milk evaporation and condensation. Lactaid, which is processed dairy products specifically for those who have lactose intolerance problems. Lactaid allegedly still contains cow’s milk protein, so 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, kaseinat, sodium or calcium kaseinat, lactalbumin, and wheyArtificial butter, Butter, Buttermilk, Casein, Cheese, cream, cottage cheese, yogurt, Casein hidrolisat , 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. Cow’s milk allergy sufferers also experiencing a very rare allergy to beef. Many people with allergies to cow’s milk can consume beef without experiencing allergy symptoms.

PREVENTION OF COW MILK ALLERGIES

Prevention of cow’s milk allergy should be done early. This happened just before arising sensitization to cow’s milk proteins, namely since intrauterin. Avoidance should be done by giving the cow’s milk hypoallergenic hydrolyzed cow’s milk to stimulate the emergence of partial tolerance to cow’s milk in the future. When it happens sensitization to cow’s milk protein or are allergic disease manifestations occur, it must be given a hydrolysed cow’s milk or milk replacer perfect cow for example soy bean milk.

Cow’s milk allergy that often arise can facilitate the occurrence of other food allergies later in life when it happens gastrointestinal damage settlement. Prevention and treatment of good and sustainable is needed to prevent food allergy is more sustained in the future .. precautions to cow’s milk allergy are also almost the same as those performed on other allergies. In general, preventive measures to cow’s milk allergy conducted in 3 phases:

Primary prevention

Conducted before the sensitization. When avoidance done since prenatal fetus from families with atopic talent. Avoidance of cow’s milk for the provision of hypoallergenic cow’s milk, cow’s milk which is partially hydrolyzed, in order to stimulate the emergence of tolerance to cow’s milk in the future because some particles masihmengandung 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. However AAAI recommend only penghondaran [gift of nuts during pregnancy.

Secondary Prevention

Performed after the sensitization but not the manifestation of allergic diseases arise. Sensitization condition is known by way of 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 by feeding cows a non alergenik, which is hydrolyzed cow's milk is perfect, or cow's milk substitutes such as soy milk that does not happen more sensitized to the manifestations of allergic diseases occur ..

Of exclusive breastfeeding is proven to reduce the risk of allergies, but it should be noted when nursing mothers diet It is also accompanied by other measures such as provision imunomodulator, TH1-immunoajuvants, probiotics. This action aims at reducing the dominance of TH2 lymphocytes cells, is expected to occur within 6 months.

Tertiary Prevention

Performed on children who have experienced the manifestation of sensitization and allergic diseases showed an early example atopic dermatitis or rhinitis, but not yet showing symptoms more severe allergies such as asthma. When the optimal action is at the age of 6 months to 4 years.

Avoidance is also a provision of hydrolyzed cow's milk or milk replacer perfect cow. Provision of preventive medicine such as setirizin, Immunotherapy, imunomodulator not recommended because it is not yet proven clinically useful.

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