Lets explore the relationship between milk and recurrent ear infections in infants.For this analysis, milk refers to cows milk and recurrent otitis media with effusion means that there is fluid in the middle (inner) ear and that the inner ear is inflamed (swollen). Effusion in this context refers to fluid. However, this fluid often does not bother the child and often goes away on its own.
How does the fluid build up?
Depending on whom you ask, the fluid build-up may happen for a few reasons. When a child has a cold, the middle ear may produce fluid (as it does in the nose) but the fluid does not drain out of the middle ear as it does from the nose.
What is the best treatment?
Traditional physicians may suggest leaving it alone or, if recurrent, treating it with antibiotics. Naturopathic Doctors often suggest removing certain foods out of the diet (mainly cows milk) to determine if the etiology is related to a food allergy.
How to spot the symptoms.
Allergic reactions to foods in adults and infants may begin within minutes to a few hours after eating the particular food. The severity of symptoms can vary from one person to another. Mildly allergic symptoms may include itching and a few hives while more severe allergic individuals may experience some of the following:
- Tingling or swelling of the lips, tongue or throat
- Abdominal pain
- Nausea, vomiting or diarrhea
Does any literature support Cows milk allergies in infants?
In 2001, Arroyave investigated recurrent otitis media with effusion in children with a known food allergy. Patients were challenged with foods to which they reacted and were evaluated via tympanometries. Skin testing was also conducted and all 25 children in the study were positive for food sensitivity.
The most common food allergies were milk, egg, beans, citrus and tomato. The elimination of these foods led to amelioration of otitis media in 22 of the 25 patients. When the children were challenged by reintroducing the food, a recurrence of the problem was found.
It is estimated that approximately 8% of children aged <3 years have food allergies. Foods can induce a variety of IgE-mediated, cutaneous, gastrointestinal, and respiratory reactions.
What research has shown us
In the journal acta otolaryngolica 1999, Juntti et al. set out to determine if cows milk allergy (CMA), was associated with recurrent otitis media in a cohort study of 56 known milk-allergic children and 204 other school children serving as the control group. A higher amount of children with CMA had recurrent otitis media.
This was defined by at least 15 acute otitis media episodes by the age of 10 years. In addition, a higher percentage of CMA children had undergone adenoidectomy and or tympanostomy (a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time) compared with the controls.
Interestingly, only children with respiratory concerns (asthma and/or allergic rhinitis) displayed a higher incidence of ear infections. Like the Arroyave study in 2001, the ear infections were only seen in the children with concomitant respiratory abnormalities.
Other larger trials with over 1700 newborns published in the journal pediatric allergy and immunology found infants on controlled milk elimination and challenge procedures with non-IgE-mediated cows milk protein intolerance had a good prognosis compared to those children with IgE cows milk protein allergy. The increased IgE response delineated the intolerance from allergy.
What this means for you
Not every child has a milk allergy. Some have no immune upregulation leading to otitis media. Conversely, a growing body of evidence supports the exploration of food allergies that may lead to decreased use of antibiotics and a drop in respiratory, gastrointestinal, dermatological and mild in-ear symptoms in infants.
George Tardik B.Sc.(hon), RHN, RNCP, (ND cand.) has been practicing nutrition for 10 years. He is a fourth year intern at the Canadian College of Naturopathic medicines RSNC clinic. Hes been featured on CBCs Newsworld, Marketplace and Sports Journal. George specializes in metabolism, weight-loss, diabetes and sports nutrition. He practices out of Natures Source. For booking appointments, please call 416.242.8500.