How To Test For Milk Allergy In Babies

What Is A Milk Allergy

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow’s milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like .

Cow’s milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.

People of any age can have a milk allergy, but it’s more common in young children. Many kids outgrow it, but some don’t.

If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction . An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

Allergy Or Intolerance What Is The Difference

A food intolerance is an inability to digest a certain food or substance in the food. Symptoms might include tummy ache, bloating, diarrhoea or headache. Symptoms may be similar to food allergy but are not life threatening7.

A food allergy is more serious than an intolerance but less common. The body makes an immune system reaction to a food, even tiny traces of the food, and occasionally this can be life threatening e.g. anaphylaxis. Allergic responses tend to be either:

• Immediate . Symptoms such as swollen eyes and lips, hives, rashes, or difficulty breathing could be seen within minutes to two hours8.
• Delayed . Symptoms such as eczema, diarrhoea/constipation, blood in the stool, respiratory symptoms, or reflux might appear within hours to several days9.
• Its possible to have a combination of types.

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

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How Long Does It Take For Formula To Leave Baby System

Prepared infant formula can spoil if it is left out at room temperature. Use prepared infant formula within 2 hours of preparation and within one hour from when feeding begins. If you do not start to use the prepared infant formula within 2 hours, immediately store the bottle in the fridge and use it within 24 hours.

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 theyre around 1 year old, and the majority of babies with milk allergies outgrow the condition by about age 3.

In the meantime, your childs 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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Algorithm For The Diagnosis And Management Of Cmpa In Formulafed Infants

Patients with lifethreatening, 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 workup 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 mildtomoderate suspected CMPA, and a diagnostic elimination diet should be initiated. Infants presenting with symptoms such as angiooedema of lips and/or eyes, urticaria and immediate vomiting are likely to have IgEmediated allergy. In the case of IgEmediated 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 CelikBilgili 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.

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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.

Cows Milk Allergy And Formula Fed Babies

If your babys formula fed and has been diagnosed with a cows milk allergy, your doctor may prescribe a special kind of extensively hydrolysed formula. Here, the proteins in the milk have already been broken down into smaller pieces and your babys immune system doesnt recognise it as an allergen. Rest assured that this process doesnt affect the nutritional value of the formula, and it will still provide the wide range of vitamins and minerals that your baby needs.

Its normal for your babys feeding patterns and habits to change when you switch to an extensively hydrolysed formula, and it may take your baby a couple of weeks to get used to their new milk. You may also notice that their stools may be different, becoming looser and greener in colour.

Many milks arent suitable for babies with a cows milk allergy. Soya-based products in particular, including soya based formula, are not recommended for babies under six months old. This is because they contain plant-based compounds with oestrogen-like properties known as phytoestrogens. Research has shown that 3050% of babies who react to cows milk-based formulas might also react to soya-based formulas10,11.

Another type of formula unsuitable for babies with a cows milk allergy, is partially hydrolysed formula. These are widely available in supermarkets, and they often feature claims that theyre easier to digest12. However, their proteins are only partially broken down and can cause an allergic reaction.

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Treatment Of Allergy To Cows Milk Protein

Modern adapted formulas are mostly made on the basis of the cows protein casein. If the baby is allergic to milk or lactose intolerant, they these compounds are not suitable. In this case, selects a mixture based on hydrolysis of the protein or the mixture, which is based on the amino acids.

Adapted infant formulas based on the hydrolysis of proteins: Frisopep, Patikat, Al, Nutrilite stst, Nutrilite TSC.

To prevent allergies, if necessary, and there is a risk of developing allergies, you can replace the usual mixture adapted mixture with partial splitting of the protein: Nutrilon HA, HA Nutrilog 2, NAN HA 1 and NAN HA 2.

When lactose allergies , it is advisable to use the following mixture: Humana HA 1, Humana HA 2, nutrilac HA, HA HiPP 1 and the HiPP HA 2.

Another alternative to cows protein mixtures are mixtures which are based on goats milk, such as NANNY. But not all believe that these compounds are worthy replacement, American pediatricians forbid if you are allergic to cow protein to use these mixtures, these mixtures include whole milk.

Should be excluded from the diet of baby fish, nuts and eggs if a child who is breast-feeding, there are allergic to cow protein. A month later the child will feel better. If there is no improvement, you should use a mixture based on protein hydrolysis, even if they do not help, then the best choice is a mixture, which is based on the amino acids.

Symptoms Of Anaphylaxis In Infants With Milk Allergy

Mostly all children and infants are allergic to certain things may be food, dust, etc. Whenever they fall in contact with them they develop symptoms such as shortness of breath and hives and it is known as an allergic reaction. These mild and severe symptoms can lead to serious allergic reaction known as anaphylaxis. The symptoms of anaphylaxis may occur when your infant becomes prone to allergy and this situation can get worse. Anaphylaxis must be treated immediately because it can cause death as well. Major symptoms are skin rashes and itching, swelling of the lips, tongue and throat, problem in breathing, dizziness or fainting, stomach ache with vomiting or diarrhea. So if your infant or child is prone to any king of allergy make sure to provide a better treatment to avoid extreme conditions like anaphylaxis.

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Does My Child Have A Cow’s Milk Allergy

What are the signs, symptoms and what to do next?

This factsheet has been written to help you understand and gain some advice on suspected cows milk allergy in babies and children. Cows milk allergy is one of the most common food allergies to affect babies and young children in the United Kingdom. While it mostly affects formula fed babies, breast fed babies can also be affected. Allergic symptoms can happen immediately after feeding or they can be delayed, as explained below.

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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How Is Milk Allergy Different From Lactose Intolerance

Lactose intolerance is characterized as a food intolerance, meaning it does not trigger an autoimmune response. Instead, lactose intolerance causes a gastrointestinal response, interfering with normal digestion when milk and dairy products are consumed.

Those who are lactose intolerant are unable to produce the enzyme lactase, which breaks down lactose . Without lactase, the digestive system is unable to break down lactose, causing symptoms such as nausea, cramps, bloating, diarrhea, and gas. While certainly uncomfortable, and can impact quality of life, lactose intolerance is not life-threatening.

Milk allergy may sound the same as lactose intolerance but there are key differences between a milk allergy and an intolerance or sensitivity to milk. Milk allergy is an immune-mediated response. If you have a milk allergy, your body will automatically respond to milk proteins as though they are harmful, dangerous compounds. As milk proteins bind to IgE antibodies created by the immune system, this triggers a chain of allergic reactions that can range from mild to severe.

In some cases, allergic reactions can even be life-threatening. This is why it is so important to properly diagnose whether someone suffers from a true milk allergy or an intolerance.

Identifying Infant Milk Allergy

Be sure to have your child evaluated by their pediatrician and/or an allergy specialist to ensure your child actually has a milk protein allergy. This is especially important because while 1% of babies have a true milk allergy, upwards of 14% of parents falsely assume their babies have this issue.

This often unsubstantiated worry that the mother’s milk is making their child ill can erode breastfeeding confidence and/or causes a huge, unnecessary disruption in the parent/infant diet.

According to researchers in a 2020 study, “Clinical trials do not provide consistent support for using maternal or infant cows milk exclusion to manage common symptoms in infants without proven CMA. We estimated that for more than 99% of infants with proven CMA, the breastmilk of a cows milkconsuming woman contains insufficient milk allergen to trigger an allergic reaction.”

So, don’t stop breastfeeding because of a suspected or confirmed allergy to cow’s milk protein, unless instructed to do so by your doctor. In fact, as mentioned above, even if your baby does have a milk allergy, you can usually still consume dairy and continue breastfeeding.

Once you eliminate these foods, you may see improvement in as little as a few days. But it can take two to three weeks to see results.

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Dietary Restrictions For Cows Milk Allergy Should Be Supervised

Exclusion and reintroduction of cow’s milk and other dairy foods should only be undertaken with advice from a medical specialist , particularly in cases of anaphylaxis. If long-term exclusion is required, an alternative source of calcium and protein is needed, to ensure adequate nutrition and growth.

Excluding foods from the diet during breastfeeding is rarely required, and if recommended, the maternal nutritional intake should be supervised, assessed and reviewed by a dietitian. Assessment and review by a dietitian is also recommended for babies and children who need to exclude cows milk and other dairy foods.

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Working With Your Doctor To Make A Diagnosis

Providing your doctor with as much information as possible about your babys symptoms will help them to make a diagnosis. The more evidence and information you can provide, the better.

Its a good idea to keep a diary of your babys symptoms, including when they occur and how long they last for, as this can help your doctor identify or rule out a cows milk allergy. For example, if your baby comes out in a rash after feeding, take a photo, make a note of how long it took for the rash to appear and how long it lasts. In addition, take a note of any vomiting, diarrhoea, stomach cramps or difficulty breathing, and when these happen in relation to eating, drinking or other activities.

Look particularly for two symptoms in two separate areas of the body, such as vomiting and a skin irritation. If this happens, be sure to inform your doctor and let them know if theres a history of allergies in your family.

Cow’s Milk Allergy Symptoms In Babies

If your babys allergic to cows milk, theyre likely to have a reaction to formula which is made from cows milk. Sometimes, but very rarely, your baby may react to your breast milk if youve recently consumed dairy products.

Symptoms to look out for include:

• A red itchy rash .
• Swelling of the lips, face and around the eyes.
• Tummy ache.
• Hay fever-like symptoms .
• Eczema.

You should consult your health visitor or doctor if your baby is affected in two separate areas of the body for example, the stomach and skin , and if they have more than one of the symptoms listed above3.

Our Baby Symptom Checker is a great tool to use if your baby is less than a year old. It includes useful tips for you to use, and a symptom summary that you can show your pharmacist, health visitor or GP. Unfortunately, theres no single diagnostic test for a cows milk allergy. Usually, diagnosis involves a combination of tests and a series of elimination and reintroduction diets in order to get to the bottom of things.

These tests usually happen once your baby has been referred to a specialist by your doctor. Remember that it’s very important to seek advice from your doctor if you suspect that your baby has an allergy so that they can be properly diagnosed and treated.

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