Dairy Allergy And Formula
If your baby breastfeeds and takes formula, a cow’s milk-based formula can cause milk allergy symptoms. Milk allergy is actually more prevalent in formula-fed babies. If formula is the cause, you may need to change the brand you use. Soy formula is an option, but it can also cause allergies in about 10% to 15% of infants who are allergic to the cow’s milk protein. A hypoallergenic formula may be used instead.
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 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 babys 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.
- Tolerated by most babies with cows 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.
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What If A Specific Food Appears To Be A Problem
If you think your baby is reacting to a particular food, then eliminate that food from your diet for 2-3 weeks to see if babys symptoms improve. If babys symptoms do improve, then this food may be a problem for your baby. Eliminating a food for less than 2-3 weeks may not be effectivecows milk protein, for example, can persist in moms body for 1½ 2 weeks, and it may be another 1½ 2 weeks before the protein is out of babys system.
Babys symptoms will usually begin to improve within 5-7 days of eliminating a problem food. Your baby may not improve immediately, however, especially if the reaction is to a food that has been a regular part of moms diet. Some babies seem to feel worse for about a week before symptoms begin to improve. Sometimes it takes several weeks to see an improvement.
One way to confirm that a particular food is a problem for your baby is to eat that food again to see whether baby has the same reaction. The more severe your babys original symptoms, the longer you may wish to wait before reintroducing it into your dietfor a very severe reaction you may not reintroduce the food at all. If you reintroduce a food and your baby does not have the same reaction as before, then baby is probably not sensitive to that food. If he does react in the same way, you will want to limit or avoid this food for a time until baby is older or in some cases until baby has weaned.
Outgrowing True Milk Allergy
Studies over the past decade, in contrast to earlier studies, suggest that outgrowing milk allergy may not be as common as previously thought, and also occurs later in childhood than was expected.
A 2007 study found based on the most accurate definition of milk allergy found that the percentages of previously allergic children who could tolerate milk at various ages were:
- 19% by age four
- 79% by age 16
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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 cows milk.
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Do Seasonal Allergies Ever Go Away
Are allergies permanent? Allergies are common, particularly in children. Some allergies tend to disappear as a person ages, but many are lifelong. In the United States, allergies are the sixth leading reason for chronic illness, with more than 50 million people experiencing various allergies each year.
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Will My Baby Outgrow Cma And When
Most children eventually outgrow a milk allergy and often can begin a switch to cows milk after they reach 1 year of age. For children who still have CMA after 12 months, its common to supplement with a hypoallergenic formula like Similac Alimentum.
Its important to work closely with your healthcare provider to determine when this transition should begin and to identify an appropriate milk-alternative beverage.
References:1. United States Census Bureau QuickFacts . https://www.census.gov/quickfacts/fact/table/US/RHI225218external icon 2. Gupta RS, et al. Pediatrics. 2018 142:e20181235.
Sources: Food allergies. Centers for Disease Control and Prevention. April 21, 2020.
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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Coping With Milk Allergy
It can be difficult to cope with a sensitivity to milk whether it represents a true food allergy, lactose intolerance, or other causes. Because milk products are a common ingredient in many packaged foods, cooking from scratch can be a relatively easy way to avoid hidden sources of milk. Here are some tips on foods and food products to avoid on a milk-free diet.
At the current time, the only treatment available for milk allergy is avoidance, though studies are looking at immunotherapy hoping for other treatments in the future.
Is My Baby Lactose Intolerant
Image credit: flickr Jules Morgan CC BY 2.0
If your baby is sensitive to dairy products it is highly unlikely that the problem is lactose intolerance, although many people may tell you so.
See Is my baby lactose intolerant? for more information.
Although cows milk protein sensitivity and lactose intolerance are not the same thing, they can sometimes occur at the same time, since food allergy can cause secondary lactose intolerance.
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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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A Child Fed With Cow’s Milk Formula With Mild
Algorithm for children < 1 year fed with cow’s milk formula and mild-moderate symptoms.
In infants with immediate symptoms or late symptoms , constipation) a CMPA can be suspected . Other causes are to be considered for patients unresponsive to treatment. Infant colic is not unanimously considered as a consequence of CMPA. The paediatrician has to consider the opportunity of a cow’s milk free diet in the most troublesome cases . Mild immediate reactions may be of difficult interpretation because they can be the result of causes different from CMPA. However, if these symptoms are strongly related to cow’s milk ingestion, we recommend to eliminate cow’s milk and follow the algorithm for severe reactions .
Regarding delayed onset gastrointestinal symptoms, other pathologies should be excluded before investigating allergic sensitization.
In mild atopic dermatitis, investigations for CMPA are not necessary in the absence of a clear relation between cow’s milk intake and onset of symptoms.
When a CMPA is suspected, infants should go on a 2-4 week diet without cow’s milk protein. Four weeks should be considered for chronic gastrointestinal symptoms. Infants should be fed with eHF or SF in children aged more than 6 months and without gastrointestinal symptoms.
When there is strong suspicion of IgE-mediated reactions, in infants who do not respond to a diet with eHF or SF an attempt may be made with a 14-days diet with AAF.
Cows’ Milk Allergy In Babies
Cows’ milk allergy , also called cows’ milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect around 7% of babies under 1, though most children grow out of it by the age of 5.
CMA typically develops when cows’ milk is first introduced into your baby’s diet either in formula or when your baby starts eating solids.
More rarely, it can affect babies who are exclusively breastfed because of cows’ milk from the mother’s diet passing to the baby through breast milk.
There are 2 main types of CMA:
- immediate CMA where symptoms typically begin within minutes of having cows’ milk
- delayed CMA where symptoms typically begin several hours, or even days, after having cows’ milk
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Signs And Symptoms Of Cmpa
Cows milk protein allergy , also known as cows milk allergy , is a common food allergy . While most babies with CMPA experience digestive problems , skin problems , respiratory symptoms and other more general allergy symptoms can also occur. With such a wide range of symptoms, recognizing CMPA can be a challenge. It is particularly difficult when symptoms are similar to the expected behavior of your baby or when they overlap with other common problems . It is also important to note that not all symptoms will occur immediately after feeding some may be delayed by up to 2 days or even a week.We understand that the symptoms can be distressing, particularly at this time when you are getting to know your baby. CMPA can be easily managed with the correct diet, so getting an early diagnosis is very important. If you suspect your baby may be allergic to cows milk protein, your doctor will guide you through the steps to a final diagnosis.
In the first instance, you should schedule an appointment with your doctor.With this website, we want to provide support so you are prepared for the appointment with your doctor, and we hope to answer questions you may have related to the diagnosis and the appropriate management of CMPA .
CMPA presents with multiple and diverse symptoms
92% of infants and young children with CMPA have 2 or more symptoms impacting at least 2 organ systems
CMPA appears during infancyYou should keep breastfeeding even if your baby has CMPAhealthcare professional
Which Children Are More Likely To Outgrow Their Food Allergy
So how can you know if your child is likely to outgrow her allergy or not?
Part of the answer may depend on other allergies your child has. Studies show that children with allergic rhinitis , asthma or other common food allergies are less likely to outgrow milk allergy. In addition, children with milk allergy who ever received baby formula during infancy were also less likely to outgrow milk allergy.
As noted under diagnosis, the most sensitive test to determine if a milk allergy is present is not a blood test, but the reaction a child has upon being challenged with the offending food. Unfortunately, some children may never outgrow their milk allergy, and their food allergy may persist into adulthood, or even indefinitely.
Milestone : Outgrowing Cows Milk Allergy
Will my child outgrow cows milk allergy?
Fortunately, sensitivity to cows milk decreases with age1 as most children outgrow their cows milk allergy.2 Children with delayed reaction cows milk allergy are likely to outgrow their allergy more quickly than those with immediate onset, while it may take longer for children with immediate onset cows milk allergy.3 The speed with which allergies resolve varies from child to child,2 but most children will outgrow their cows milk allergy by the time they are five years old.
What can I do to help manage my childs allergy?
Remember that getting your child back to cows milk may help them outgrow their allergy sooner and assists their growth and development.1 You can support this by following the milk ladder for delayed milk allergy in conjunction with healthcare advice, step by step, until your child can tolerate fresh cows milk without a reaction. For children with immediate milk allergy this must be guided by a healthcare professional, such as an allergy doctor/ nurse or dietitian and a different process to the milk ladder will be used. For some children, this may be a slow process but keeping any milk protein they can tolerate in the diet every day will help. A broad range of foods in the diet is also important to support overall health.
My child is over five and has an ongoing milk allergy. What is the likelihood they will outgrow the milk allergy?
What support is there for older children with foods allergies?
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.
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