Is It Really A Milk Allergy
Your pediatrician may mention the term “allergy” without offering clarification that may help you get a better handle on exactly what your child is facing. Here are the specific types of reactions your child may have to milk:
Classic milk allergy: Classic milk allergy involves both having allergic symptoms within two hours of consuming milk and having the presence of allergic antibodies, or IgE, against various proteins in milk. Allergic symptoms can include hives, swelling, difficulty breathing, nausea/vomiting, diarrhea, and/or anaphylaxis. Presence of antibodies alone does not mean a person has allergy
Food protein-induced enterocolitis syndrome : Food protein-induced enterocolitis syndrome is a non-IgE immune-mediated reaction that typically presents with vomiting, diarrhea and/or lethargy around 90 minutes after consuming milk or other trigger. Sometimes milk IgE is elevated but most often it is not. FPIES typically occurs in young infants and is commonly outgrown by age three.
Lactose intolerance: Lactose intolerance is a gastrointestinal syndrome that presents with abdominal discomfort, gassiness, bloating, and/or diarrhea. It is typically caused by insufficient lactase, an enzyme that digests lactose. Replacing lactase enzyme or consuming milk products that have lactose removed, prevents symptoms. Lactose intolerance typically occurs in older children and adults and is less likely to be outgrown.
Cows Milk Allergy Usually Resolves
Around 80% of children will outgrow their cows milk allergy by the age of three to five years. Your doctor should advise if further allergy testing and food allergen challenges are needed. These are usually performed in hospital clinics and supervised by a clinical immunology/allergy specialist.
ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.
ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.
For more information go to www.allergy.org.au
To donate to immunology/allergy research go to www.allergyimmunology.org.au/donate
How Is A Milk Allergy In Babies Treated
If it turns out that your newborn is one of the 2 to 3 percent of babies who has a milk allergy, dont despair. Many children outgrow a milk allergy by the time they’re around 1 year old, and the majority of babies with milk allergies outgrow the condition by about age 3.
In the meantime, your child’s doctor may recommend the following:
- If your baby is formula-fed: Your pediatrician will suggest switching to a different formula. Because many babies with milk allergies are also allergic to soy , the doctor may suggest a hypoallergenic formula with hydrolysate protein, which has milk proteins that are already partly broken down, so its less likely to cause a reaction.
- If youre breastfeeding or exclusively pumping: Your pediatrician will likely recommend that you ditch dairy in your diet to see whether that makes a difference to your baby. Of course, making a major change to your diet is probably the last thing you want to think about when dealing with a fussy newborn, but it may very well resolve the issue. If you do eliminate dairy, be sure to talk with your doctor about how to make sure youre still getting enough calcium and other nutrients in your diet.
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What Is Cows’ Milk Allergy
Cows’ milk allergy occurs when your babys immune system reacts to the protein in cows’ milk. The body’s immune system fights off harmful bugs and infections. The immune system of babies with CMA identifies the protein in cows’ milk as being harmful. This produces an allergic response, which can present as a wide range of symptoms . Cows’ milk contains 2 types of protein casein and whey . Your baby may be allergic to one or both of these proteins.
Some Soy Products May Contain Small Amounts Of Cow’s Milk Protein And May Need To Be Avoided If Your Child Is Highly Allergic Ask Your Doctor Or Dietitian
These include:
Soy yoghurt
Soy cheese .
Note: Toffuti brand sour cream, cream cheese and cheese is milk free
Coconut oil based cheeses such as Bio cheese and Oilana usually dont contain cows milk.
Milk and Nut-Free Chocolates
Sweet William – milk chocolate/ tangerine milk chocolate chocolate spread www.sweetwilliam.com.au
Available in Woolworths, Coles , IGA , health food shops.
Kinnerton -Allergy free-chocolates: Easter Eggs, Chocolate bars & Lollipops .
Childrens character chocolates
Available at selected Target, Big W, Woolworths, Coles, David Jones, Aldi & IGA stores.
Also available online at www.kinnerton.com.au
Willow – chocolate bars, Christmas, Easter and Valentine novelties, frogs
Available 03 9587 1079 or via www.allergyblock.com.au
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Can Babies Grow Out Of Allergies Like Cma
Most babies grow out of cows milk allergy and can return to a normal diet, consuming cows milk without allergic issues, but the timing will differ for each baby.
Although cows milk allergy is the most common food allergy in children under 3 years old, the good news is that more than 75% of babies with cows milk allergy grow out of it in early childhood . When a baby has grown out of cows milk allergy, they can consume cows milk without allergic issues in other words, they can return to a diet that includes dairy foods.
If your baby is diagnosed with cows milk allergy, a healthcare professional will advise you when and how to test whether they have started to grow out of their allergy. In the meantime, suitable dietary changes would be advised by a healthcare professional to manage the allergy.
Can An Infant Outgrow Cows Milk Allergy
Most children will outgrow cows milk allergy.
Studies show that most children with non-IgE-mediated reactions will outgrow cows milk allergy by the time they are 3 years old.
For children with IgE-mediated reactions, studies show that about half of these children will outgrow cows milk allergy by the time they are 5 years old. Evidence suggests that a cows’ milk protein allergy is more likely to persist in these children if they have asthma or allergic rhinitis, or if they have more severe reactions or higher milk-specific IgE antibody levels. Even so, its rare for adults to have a cows milk allergy.
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What About Baby Formula
The most commonly used formula are made from cows milk proteins and will cause reactions in cows milk allergic children. Hypo-allergenic formulas (HA are not appropriate for babies with diagnosed milk allergy. Some infant formula are made from soy and do not contain milk. Soy based formulas are suitable for many infants who are allergic to cows milk.
There are special formulas made for milk allergic children that can be prescribed by your doctor if your baby cannot have a soy formula.
Not All Reactions To Cows Milk Are Due To Allergy To Cows Milk Protein
Lactose intolerance: This is caused by the lack of the enzyme lactase, which helps to digest the milk sugar called lactose. Symptoms include diarrhoea, vomiting, stomach pain and gas . This condition is uncomfortable but not dangerous and does not cause rashes or anaphylaxis. Allergy tests to cows milk are negative in people with lactose intolerance. Diagnosis is by temporary elimination of lactose and reintroduction.
Milk, mucus and cough: Some people complain that when they drink cows milk or eat other dairy foods, that their throat feels coated and mucus is thicker and harder to swallow. Research has shown that these sensations occur with similar liquids of the same thickness and are not due to increased production of mucus.
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Algorithm For The Diagnosis And Management Of Cmpa In Formula
Patients with life-threatening, particularly respiratory symptoms or anaphylaxis, conditions need to be referred immediately to an emergency department experienced in the treatment of this condition. In all the other situations, the initial step in the diagnostic work-up for CMPA is clinical assessment accompanied by history taking, including establishing whether there is a family history of atopic disease .
The algorithm differs according to the severity of symptoms . If the infant does not present alarm symptoms , the case is considered as mild-to-moderate suspected CMPA, and a diagnostic elimination diet should be initiated. Infants presenting with symptoms such as angio-oedema of lips and/or eyes, urticaria and immediate vomiting are likely to have IgE-mediated allergy. In the case of IgE-mediated allergy, improvement offers a safety net before challenge. A positive SPT increases the likelihood of a positive food challenge but not the severity of the reaction. In the study from Celik-Bilgili and coworkers, 60% of the patients with a RAST class 1, 50% in class 2, 30% in class 3 and even 20% in class 4 had a negative food challenge.
Avoiding A Milk Allergy Reaction
If You’re Breastfeeding
If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.
If You’re Formula Feeding
If you’re formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.
You also might see “partially hydrolyzed” formulas, but these aren’t truly hypoallergenic and can lead to a significant allergic reaction.
If you’re concerned about a milk allergy, it’s always best to talk with your child’s doctor and work together to choose a formula that’s safe for your baby.
Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy are not safe for infants.
If you have any questions or concerns, talk with your child’s doctor.
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Cows Milk Allergy In Children: Symptoms And Diagnosis
Cows milk allergy is a common condition in infants and young children. The severity of the condition varies for each individual. It is important for parents to keep an eye out for warning signs. By learning more about this condition and what it entails, parents can take the necessary steps towards providing their child with the right treatment, leading to a full recovery.
Is Breastfeeding Safe In Babies With Cma
You can continue to breastfeed infants with CMA. Breastfeeding alone is the best source of nutrition for all babies until the age of 6 months. For babies older than 6 months, you need to slowly introduce solids because breastfeeding alone is not enough for growth and development. If possible, babies should continue to be breastfed until they are at least 12 months of age. For babies that are breastfed only, mothers should continue breastfeeding. Many women can continue to have cows milk or dairy in their own diet without affecting the baby, but some women will also need to avoid but must avoid any foods or drinks that contain cows’ milk products or dairy. Your doctor or dietitian can help make this decision. Mothers who are avoiding dairy may need help to make sure they are getting enough calcium.
If this does not resolve symptoms, or if breastfeeding is not possible or adequate, or if you wish to wean your infant before they are aged 12 months, ask your doctor or dietitian for advice on which infant formula to try.
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Food Challenges For Babies With Cma
When your toddler has been on a cows milk protein-free diet for some time and is at least 912 months old, your doctor may request an oral food challenge a process where food is eaten slowly, in gradually increasing amounts, under a doctors supervision to see if they have outgrown a cows milk allergy. You may have done this before when your doctor was assessing your baby for cows milk allergy.
How Is Cma Diagnosed
Diagnosis of IgE CMA is usually obvious if symptoms occur soon after having cows’ milk or other dairy foods. This can be confirmed by your doctor after taking a medical history and using allergy tests. Allergy tests can be used to confirm the presence of IgE antibodies. The diagnosis of non-IgE delayed allergic reactions is more tricky. This is made by a specialist paediatrician or clinical immunology/allergy specialist. This usually involves excluding cows’ milk and other dairy foods from your baby’s diet for a trial of 14 weeks to check for improvement. Then your doctor would advise you to gradually introduce some cows’ milk and other dairy foods to see if the symptoms come back. Some forms of non IgE dairy allergy require more cautious food reintroduction.
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Alternative Milks For Babies
Soy protein formula
- Tolerated by most babies with cow’s milk allergy.
- Unsuitable for babies allergic to soy.
- Usually only recommended in babies over six months old.
Cows milk based extensively hydrolysed formula
- EHF has been treated with enzymes to break down most of the cows milk proteins and it is usually the formula of first choice in cows milk allergic babies.
- EHF is not suitable for babies who have had anaphylaxis to cows milk.
- Some EHF brands are available without prescription.
- An amino acid based formula is usually prescribed if a baby reacts to EHF.
- Partially hydrolysed formula is not a suitable formula for babies with cows milk allergy as enough allergenic protein is usually present to trigger an allergic reaction.
Rice protein basedformula
- May be used as an alternative formula to EHF or soy protein formula and continued or changed based on specialist advice.
- Available without prescription.
- Should not be used in babies with food protein induced enterocolitis syndrome to rice.
Amino acid based formula
- AAF is necessary in around one in ten babies with cow’s milk allergy.
- AAF is usually prescribed when an EHF or soy protein formula is not tolerated.
- AAF is tolerated by most babies with cow’s milk and soy allergies.
Alternatives To Cows Milk
Its important to important to find alternative sources of calcium.
For children aged up to 1 year, these include:
- soy protein formula, which most babies who are allergic to cows milk will tolerate and is usually only recommended in babies aged over 6 months
- cows milk based extensively hydrolysed formula this formula has been treated to break down most of the cows milk proteins, but it is not suitable for babies who have had anaphylaxis to cows milk
- rice protein based formula
- amino acid based formula
For children aged over 1 year, soy milk is the preferred alternative. Your doctor and/or dietitian may recommend rice, oat or nut milks, depending on your childs condition.
Alternative milks enriched with calcium must contain around 120mg/100mL to be a suitable cows milk replacement.
Talk to your doctor or a dietitian about cows milk alternatives for your child.
This factsheet from The Royal Childrens Hospital lists alternative foods to cows milk.
Follow the links below to find trusted information about allergic reactions to cow’s milk.
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If Your Child Has An Allergic Reaction
If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.
If your child has symptoms of a serious reaction :
- Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
- Then, or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.
Alternative Milks In Children Over One Year Of Age
- Soy milk, calcium enriched rice, oat or nut milks may be recommended by your doctor and/or dietitian, depending on your childs condition.
- It is important to check if they contain adequate levels of protein and fat for young children for growth.
- Alternative milks enriched with calcium must contain around 120mg/100mL to be a suitable cows milk replacement.
- Children with multiple food allergies may need to continue on specialised formula to meet their nutritional requirements.
- Babies should be reviewed by a dietitian at around 12 months of age so the need for formula can be considered.
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Positive Challenge: Cmpa Confirmed
If symptoms of CMPA reappear, the suspected diagnosis of CMPA is confirmed and the infant should be maintained on an elimination diet using eHF or AAF until the child is between 9 and 12months of age, but for at least 6months, whichever occurs first. The challenge is then repeated. If it is possible to follow the infant with IgEmediated allergy with SPTs and/or specific IgE determination, normalisation or improvement of these tests would help in choosing the time point of challenge. Supplementary feeding should be introduced carefully to avoid accidental intake of CMP. Nutritional counselling must ensure a sufficient intake of the therapeutic formula to guarantee adequate calcium intake.
What Is Milk Intolerance And Milk Allergy
Around 1 in 10 young children has a reaction when they drink cow’s milk. This could be because they have a lactose intolerance or a milk allergy. Milk allergy is much more common than lactose intolerance in children under 5.
Lactose intolerance is a problem with the digestive system it means your child doesn’t have the enzyme needed to digest lactose, which is the sugar in milk.
Milk allergy, however, is a problem with the immune system the body reacts to the protein in milk. An allergy usually involves other parts of the body as well as the stomach, and may cause symptoms such as a skin rash or swelling of the face.
Your doctor can confirm whether your child is lactose-intolerant or has a milk allergy by doing some medical tests. Don’t use unproven tests such as Vega, kinesiology, Alcat or allergy elimination tests for children. A milk intolerance is very unlikely to be the cause of mucus or coughing.
Many young children grow out of their intolerance or allergy. But don’t start giving them cow’s milk until your doctor tells you it’s safe to do so.
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