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What Causes Cows Milk Protein Allergy

Delayed Reactions To Cows Milk And Other Dairy Foods

The most common symptoms of Cow’s Milk Protein Allergy (CMPA)

Delayed reactions usually occur after two or more hours after consuming cows milk or other dairy foods. Symptoms may include an increase in eczema or delayed vomiting and/or diarrhoea. Allergy tests to cows milk are usually negative for these reactions.

Diagnosis should be made in consultation with a specialist paediatrician and/or clinical immunology/allergy specialist. This usually involves excluding cows milk and other dairy foods from the diet for a trial period of one to four weeks to check for a clear improvement. A planned reintroduction of cows milk and other dairy foods should occur to confirm diagnosis before longer term exclusion is advised.

Immediate Cow’s Milk Protein Allergy

In babies with immediate cow’s milk protein allergy, symptoms usually present within a few hours of having cow’s milk protein. The immediate reaction to cow’s milk protein allergy is caused by your baby or child’s immune system producing IgE antibodies which causes the symptoms of the allergic reaction to happen very quickly.

Milk Protein Allergy Vs Milk Intolerance

Milk protein allergies are not the same as a milk intolerance. Those with a milk intolerance do not have enough of the enzyme lactase in their bodies, which limits their ability to break down the lactose in dairy products. This results in digestive distress and symptoms.

A milk protein allergy is very different and involves a histamine response triggered by the bodys immune system. This results in system-wide symptoms that can affect much more than just digestion.

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What Causes Allergic Reactions To Milk

As with all allergies, a milk allergy involves the body having a strong reaction to a trigger. In the case of a milk allergy, that trigger most commonly is the alpha S1 casein protein in the milk. The body reacts to this protein by releasing histamines. These histamines, in return, trigger an immune response in the body.

This immune response causes a variety of symptoms including respiratory symptoms, digestive troubles, and itchiness. The cause of a milk allergy is very different from the cause of lactose intolerance, which is triggered by the lack of the lactase enzyme in the body.

Cmpa Vs Lactose Intolerance

Is Your Child Allergic to Cow


CMPA is a food allergy caused by a baby’s immune system reacting to proteins in cow’s milk. Some babies may develop CMPA after eating or drinking products containing cows milk protein, which can cause an immune reaction resulting in allergic symptoms. There are a few different factors that can help explain why your baby may have CMPA . However, the reasons for developing CMPA are different for every baby, and there is no need to avoid cows milk in your babys diet unless your baby is diagnosed with CMPA.

There are different mechanisms behind CMPA, based on how a baby’s immune system reacts to cow’s milk proteins: IgE-mediated and non-IgE-mediated . IgE-mediated symptoms of CMPA can occur within minutes of digesting cows milk protein, and normally result in rash , swelling of the lips and eyelids, vomiting and wheezing. Symptoms of non-IgE-mediated CMPA usually occur after a couple of hours of digesting cows milk protein and usually result in gut and skin-related symptoms. Depending on the observed symptoms and the underlying mechanism, your doctor may decide to perform different diagnostic tests.

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What Is The Treatment Of Cow’s Milk Protein Allergy

Treatment of cow’s milk protein allergy is through complete elimination of cow’s milk from the baby’s diet. Breastfeeding mothers are sometimes also required to remove cow’s milk protein from their diet if the baby or child with cow’s milk allergy is very sensitive to cow’s milk protein. Dietetic therapy is particularly important in these cases to ensure the mother and baby are receiving adequate energy and nutrients for breastfeeding. Our dietitians can ensure your baby or the maternal diet is adequate in energy and nutrients for your baby to grow and develop regardless of their allergy.

For cow’s milk protein allergy, an elimination diet is usually implemented for around 9-12 months. During this time your baby or child will need alternative formulas and cow’s milk protein free weaning foods, all of which our dietitians can help you with. If your baby is formula fed, they may need to be prescribed a formula which is hydrolysed . After this period of elimination, cow’s milk protein can be reintroduced to your baby or child, as in most cases, babies and children will grow out of this allergy by age five, or sooner.

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Alternative Tests For Food Allergy

The National Institute for Health and Care Excellence recommends that testing should not be sought from unreliable sources such as online or alternative practitioners. Such testing may include kinesiology, hair analysis, Vega testing and other blood tests. These should be avoided as there is no scientific evidence to support their use in diagnosing any food allergy and such testing may result in the unnecessary removal of important food groups from your babys or childs diet.

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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.

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Signs And Symptoms Of Milk Allergies

Cows Milk Protein Allergy in Infants – Dr. Aliza Solomon

If your child is allergic to milk protein, it may cause symptoms in multiple areas of the body, including:

Skin: hives and may include mild to severe swellingLungs: difficulty breathing, shortness of breath, coughing or wheezingEyes: itching, tearing or rednessThroat: tightness, trouble breathing or inhalingStomach: repeated vomiting, nausea, abdominal pain and cramping, or diarrheaNose: congestion, copious clear discharge, sneezing or itchingNeurologic: change in behavior or mood, dizzinessDrop in Blood Pressure: This is the most dangerous symptom of a severe allergic reaction

If your child experiences any of these symptoms after consuming milk or dairy, call your pediatrician and arrange to have your child tested by a pediatric allergist.

If a child has any two systems involved from the above list, this means they may be experiencing anaphylaxis.

If your child has symptoms of anaphylaxis, call 911 immediately.

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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.

Which Factors Can Increase A Babys Risk Of Developing Cma

A family history of allergy increases the risk of a baby developing a food allergy2. However, even babies with no family history of allergy can develop cows milk allergy a babys environment can affect the likelihood of developing an allergy13-15.

Bacteria and other microorganisms in the gut have a role in the healthy functioning of the body, including the immune system16. When the delicate balance of the gut microbiota is disrupted and the number of bad bacteria outweighs the good bacteria , the immune system can start to react incorrectly to harmless things, such as milk protein5,6.

Gut microbiota dysbiosis is linked to an increased risk of food allergies, including cows milk allergy. 14-16 Specifically, infants with food allergies appear to have fewer good bacteria in their gut compared with healthy, breastfed infants17-19.

Things that can upset the balance of the gut microbiota include:

  • Repeated courses of antibiotics during infancy, which can kill both bad bacteria and good20.
  • Exposure to pollution21,22
  • C-section delivery: babies who are born vaginally come into contact with beneficial bacteria that C-section infants are not exposed to23

Gut health can be improved by good nutrition and consumption of prebiotics and probiotics24.

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Suspected Immediate Allergic Reaction

If immediate cows milk allergy is suspected your GP is likely to arrange a referral to a childrens specialist allergy service for allergy testing and further management. The two tests which help diagnose IgE reactions are a skin prick test and a specific IgE antibody blood test . Usually the information from the allergy-focused history and the tests will be enough to confirm the diagnosis. However, if information and/ or results of the tests are not clear, then an oral milk challenge may be needed to confirm or exclude whether there is an IgE mediated cows milk allergy.

The referral process and waiting times to see a specialist will depend on where you live, and the allergy service and resources in your area. Allergy UKs Helpline on 01322 619 898 can help signpost you to an approved NHS or Private allergy clinic. If you choose not to be seen through the NHS you have the choice to pay to see a private allergy doctor. Whilst waiting for an NHS or private appointment, your GP or Healthcare Professional should advise you on the dietary changes that you will need to start immediately.

What Is Lactose Intolerance

Is It Cow

In contrast to CMPA, lactose intolerance does not involve the immune system. Instead, it is the inability to digest the lactose sugar found in cows milk, and it is very rare in children younger than 5 years of age. Lactose is one of the most important carbohydrates in breast milk and provides many benefits to babies. Lactose helps to promote healthy gut flora and calcium absorption.

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Causes Of Cows Milk Allergy

Milk allergy is most commonly caused by an allergy to cows milk, although some people are allergic to milk from other animals such as goats, sheep and buffalo.In all allergies, the immune system reacts to triggers, also known as allergens. Your immune system produces antibodies that detect the allergen, causing inflammatory reactions and the release of chemicals, including histamine, which cause allergic symptoms.

In the case of milk, the triggers are milk proteins including whey and casein. You or your child may be allergic to either one of these proteins, or both.

is needed into the causes, diagnosis and treatment of food allergy.

What Are The Symptoms Of A Milk Allergy

Allergic reactions to foods usually begin within minutes of eating the allergen-containing food though may occur up to 2-3 hours after ingestion. The severity of symptoms can vary widely from one person to another. Mild symptoms may include itching and a few hives while a severe allergic reaction may include life-threatening symptoms, such as difficulty breathing and a sudden drop in blood pressure. The symptoms of an allergic reaction may include any or several of the following:

  • Drop in blood pressure and loss of consciousness.
  • Severe reactions can result in death.

Other things to keep in mind if you or a loves one has milk allergy:

  • Many people allergic to cows milk may not tolerate milk from other mammals, such as milk of goats or sheep.
  • Less commonly, some people with cows milk allergy may have a reaction after eating beef.
  • History of a mild reaction does not mean a subsequent reaction will also be mild.
  • History of a severe reaction does place you at risk for a subsequent severe reaction.

Your doctor can make recommendations on alternatives to milk-based on your childs age.

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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.

Who Gets A Milk Allergy

Cow’s milk protein allergy: how do I know if my child has CMPA?

In this article, milk refers specifically to cows milk and not to other types of milk such as soymilk, rice milk, goats milk, etc., unless otherwise specified.

Milk is one of the most common food allergens. An allergen is a food that causes an allergic reaction, such as hives, swelling, and trouble breathing. Although a milk allergy occurs most often in young children, it can appear at any age. The allergic reaction can be triggered by milk-containing foods that had been previously eaten without any problems.

A milk allergy can develop in both formula-fed and breastfed infants. Some infants have a type of cows milk allergy commonly referred to as cows milk protein allergy, which causes blood in the stool. Other infants have an allergic reaction that includes immediate symptoms, such as hives and vomiting. In both cases, many infants will outgrow the symptoms during childhood.

A milk allergy is not the same thing as lactose intolerance. Lactose intolerance is the inability to digest lactose, a sugar found in many dairy products. This leads to bloating and diarrhea after eating or drinking lactose-containing foods. Lactose intolerance is uncommon in infants and young children and is more common in adults.

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Suspected Delayed Allergic Reaction

If delayed cows milk allergy is suspected, skin prick testing and/or blood tests are not helpful. The diagnosis for delayed allergy needs to be confirmed or excluded by starting a trial elimination of all cows milk protein either from you babys diet in the case of a formula fed baby or from your own diet if you are exclusively breast feeding. Those babies who are formula fed need to be prescribed a special low allergy formula .

If it appears that your baby has reacted to cows milk protein coming through in your breast milk, you will need to eliminate all cows milk and all products containing cows milk from your own diet. This trial elimination diet will need to be guided by your GP or healthcare professional. If you are still exclusively breast feeding, your doctor may well wish to refer you to a dietitian to ensure that both your on-going nutritional needs and those of your baby are being met.

In the less common case where the suspected allergy symptoms are considered severe, your doctor will still need to advise starting this elimination diet. However if a clear improvement should be seen in the symptoms your doctor should not be advising any reintroduction of cows milk protein at home to confirm the diagnosis. The diet should be continued and the need for early referral to a childrens specialist allergy service for ongoing assessment and care should be discussed and made as soon as possible.

Dairy Breeds And Polymorphisms In The

A study involving Norwegian Red dairy cows . Casein haplotypes and their associations with milk production traits in Norwegian Red cattle. Genetics, Selection, Evolution., 41, 1-12.) found favorable genetic association of the A2 allele with higher milk and protein production. A similar result was obtained by Olenski et al. Olenski, K., Kamiski, S., Szyda, J., & Cieslinska, A. . Polymorphism of the beta-casein gene and its association with breeding value for production traits of Holstein-Frisian bulls. Livestock Science, 131, 137-140., who found a positive association between the A2 allele and the genetic merit for milk and protein production, and a negative association between this gene and the genetic value for the fat percentage in Dutch cows in Poland. Therefore, on top of adding value to human health, A2 allele beta-casein may be associated with higher production of milk and protein in cattle. New Zealand currently has dairy farms producing only milk with A2 protein , due to assumptions that this variant is not harmful to human health, as opposed to variant A1 .

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How Can You Prevent Milk Allergy

The cause of milk allergy remains unknown as do prevention strategies, but your healthcare provider may be able to provide guidance for parents of new babies if someone in the family has been found to have a certain type of allergy.

If you do have an allergy to milk or milk products, you can best prevent a reaction by completely avoiding milk and milk products.

Breastfeeding A Baby Who Can’t Tolerate Milk

Milk Allergy

If your baby is lactose-intolerant, you don’t need to change your diet. It doesn’t matter how much dairy you consume, the amount of lactose in your milk will be the same.

However, if your baby is diagnosed with milk allergy, you will need to remove all dairy from your own diet too. You will need calcium and vitamin D supplements every day. Your doctor or allergy specialist will advise you.

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