Exploring Cow's Milk Allergy/ Milk Intolerance

Cow's milk protein allergy  is one of the most common food allergies in children, often appearing during their first year. Many children outgrow this allergy by age 5.

What is cow's milk intolerance?

It's an allergic reaction to cow's milk and products made from it, like cheese, cream and yoghurt.

Symptoms include:

1. Skin issues such as itching, redness, rashes, and eczema.

2. Digestive problems like nausea, vomiting, reflux, constipation, and abdominal pain. In young children, there may also be irritability, colic, food refusal, and slow growth.

3. Respiratory symptoms like a runny or itchy nose, coughing, difficulty breathing, and wheezing. 

Diagnosis can be tricky due to vague symptoms.

How common is it?

Exact numbers are hard to pin down, but it's thought to be the second most common food allergy after eggs. It affects about 7% of formula-fed babies but only about 0.5% of breastfed babies, who usually have milder reactions. Exclusive breastfeeding may offer some protection. It typically shows up by age 1, especially in children with other allergies or family history.

Types of different allergic reactions to milk:

1. Slow allergic reactions:

In the medical terms, we call them non-immunoglobulin E-mediated reactions (non-IgE-mediated allergy).

Slow allergic reactions that occur about 2-72 hours after consuming milk. These  reactions vary from eczema, gut symptoms such as pain, reflux or colic or breathing symptoms.

2. Fast allergic reactions:

Also known in the medical jargon as Immunoglobulin E-mediated reactions (IgE-mediated allergy). Fast allergic reactions causing skin rashes and vomiting. They occur within minutes to up to two hours of milk consumption. They are triggered by the body releasing a chemical called histamine, therefore antihistamine medications can help treat the symptoms. It is extremely rare that cow's milk would lead to a life-threatening anaphylactic reaction.

3. Mixed reactions with components of both kinds of above reactions.

Diagnosing cow's milk protein allergy: 

1. Doctors often recommend removing milk from the child's diet for at least two weeks to see if symptoms improve. This is because slow reactions take a while to settle. Once this is successful, a challenge test may then be done with a small amount of cow’s milk. If the same original symptoms recur after re introducing milk, the diagnosis is reconfirmed. Please note that a challenge may not show positive until a few weeks. A challenge test should be repeated every few months because the child is expected to grow out of cow’s milk allergy over time. 

2. For IgE mediated allergy, diagnostic process skin prick or a blood test. These are specialised tests which are done in hospital setting by a paediatrician usually therefore would often involve referral to children’s allergy teams. 

Treatment and management:

1. Breastfeeding babies: Mothers who breastfeed  babies with cow's milk allergy need to remove milk and dairy from their diet. However, these mums should then be prescribed a supplement of calcium and Vitamin D to avoid their own nutrient deficiency.

2. Special formula milk is available for bottle-fed babies, in which the proteins are broken dawn so that they do not cause the same allergic reactions. Your GP or healthcare provider should be able to provide it on prescription.

3. Babies on a milk-free diet should be referred to a specialist children’s dietitian to ensure proper nutrition to aim towards a balanced diet with enough calcium.

4. Reading food labels is crucial, as milk can hide in various products. Beware of milk prodcuts on food labels like casein, whey, curd, butter, yoghurt, and cheese in packaged foods

5. Most children outgrow this allergy by age 3 to 5 years.

Alternative Options to Cow's Milk:

If your doctor suspects cow's milk protein allergy, they may recommend a completely cow's-milk-free diet for your child until they reach 9-12 months of age. This exclusionary diet should last for at least six months. Your doctor can prescribe one of specialised formula milks suitable for your baby, as there are several varieties available.

1. Hydrolysed Milk: 

Extensively hydrolysed milk is typically the first option to try. In this type of milk, the protein is broken down (hydrolysed) into smaller pieces to prevent triggering a reaction. Examples include Similac Alimentum®, Nutramigen Lipil® 1 and 2, and Pepti® 1, 2, and Junior.

2. Amino Acid (AA) Formula:

If your baby continues to exhibit symptoms on a hydrolysed formula, they may be recommended an amino acid (AA) formula. This option is sometimes preferred as the first option of specialised milk, if the allergy is severe or if there are multiple allergies. The protein in AA formula is completely broken down into its smallest units, called amino acids, to prevent any cow's milk protein reaction. Examples of amino acid formulas include Neocate® and Nutramigen® AA.

3. For infants under the age of 6 months, breast milk or specially developed infant formula milk should be their primary source of nutrition up to the age of 1 year. Cow's milk can then be gradually reintroduced.

Other Alternatives:

While some people consider goat's milk or other mammal milks to be more easily digestible than cow's milk, they are not likely to improve confirmed cow's milk protein allergy as the proteins in these milks are similar to those in cow's milk.

Can I use lactose- free milk instead?

Using lactose-free milk, which is low in lactose sugar, will not address the issue, as it is the protein, not the lactose, in cow's milk that causes the problem.

What about Soya milk?

Soya milk is generally not recommended for children allergic to cow's milk, as soya is another common cause of childhood food allergies. It should not be used as the main drink for babies under 6 months old. However, it may be recommended by a healthcare professional after this time if the child is not allergic to it.

When will my child be referred to a paediatrician?

Referral to paediatrician may be made by your GP in the following conditions:

• Suspected IgE-mediated allergy 
• The child is not growing well.
• Any severe reactions.
• Multiple food allergies suspected.

What is Lactose intolerance?

This is different from cow's milk protein allergy and results from the body's inability to digest lactose, a sugar in milk. It's common but typically develops later in childhood or adulthood.

I hope you find this article useful and I wish your queries on this topic have been answered!

(Article written on 25/02/2024)