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Cow’s milk allergy in infants: How to identify it and what to do about it?

What is cow’s milk Allergy?
Cow’s milk allergy is a reaction to one or more milk proteins and can cause a wide range of symptoms in a child.

When do children develop cow’s milk allergy?
Many babies become allergic to milk before one month of age with most babies presenting within their first year of life. Studies show that about 2.5% of babies develop cow’s milk allergy at some point. The good news is that more than 80% of these babies will outgrow their allergy by 5 years of age. Babies who are born into families where the mother, father or a sibling suffers from food allergies, asthma, eczema or hay fever are more likely to develop cow’s milk allergies than those without a family history.

What are the signs and symptoms to look out for?
Cow’s milk allergy can present in a number of different ways. The symptoms or signs allergic babies develop after consuming cow’s milk, either via breast milk, as a drink or in a food, are normally grouped according to the time it takes for the symptoms to appear following intake of cow’s milk protein. ‘Immediate type’ symptoms tend to appear within seconds to two hours of eating or drinking the food and the baby can show signs of lip swelling, itch, hives (looks like tick bites), rashes, red flushing of the face or body, worsening of their eczema, or breathing difficulties. The more delayed type symptoms associated with cow’s milk allergy can present as nausea, vomiting/reflux, diarrhoea, constipation, blood in stools, redness around the anus, progressive worsening of eczema or problems with gaining weight.

It is important that parents or carers should be able to distinguish cow’s milk allergy from lactose intolerance: Lactose intolerance can result in symptoms of diarrhoea, bloatedness and perhaps colic/tummy ache. These symptoms can be confused with those of an infant who has cow’s milk allergy and parents/carers may need the help of a healthcare professional to differentiate between them. It’s also important to realise that all of the symptoms mentioned here may be completely unrelated to cow’s milk allergy and cow’s milk should never be avoided without the involvement of a health professional.

Who should parents and carers speak to when they are concerned?
If parents/carers recognise any of these symptoms in a baby, it is recommended to speak to the health visitor or GP. The recent NICE guidelines on Food Allergy in young children (http://www.nice.org.uk) recommend that these health professionals, with the help of a dietitian, should be able to diagnose and care for a baby with a milk allergy. In more severe or complex situations, the baby will be referred to see a paediatrician or paediatric allergist.

How is cow’s milk allergy diagnosed?
Depending on the type of symptoms your baby presents with, your doctor may want to do some blood tests or skin tests. For the majority of cases, taking cow’s milk out or your diet (if breastfeeding) and your baby’s diet (formula and food) followed by a reintroduction of the cow’s milk at home or in hospital is the only way of diagnosing cow’s milk allergy. The NICE guidelines strongly advise against the use of tests such as vega testing, hair analysis, applied kinesiology or IgG testing for the diagnosis of food allergy.

How is cow’s milk allergy managed?
Mothers who are breastfeeding should continue to breastfeed and may be advised to avoid cow’s milk containing foods from their diet. This should always be done with the help of a dietitian, to make sure that the mother gets all the nutrients she needs during breastfeeding. If the breastfeeding mother needs a top up feed for her baby, a hypoallergenic formula should be suggested. Amino acid formulas contain no milk proteins, whereas extensively hydrolysed formulas are based on milk proteins that have been broken down to the point where they are tolerated by many babies with cow’s milk allergy. These formulas are also recommended for cow’s milk allergic infants who are not breastfed. However, soya based formula should never be used in infants under the age of 6 months, due to the phytoestrogen (similar to oestrogen hormone) content of the soya milk. The dietitian will also be able to advise the mother about appropriate weaning foods for the cow’s milk allergic child.

In summary, infants can develop cow’s milk allergy from a very early age. There are a number of signs and symptoms to look out for and a health visitor or GP may be able to guide you through the process of diagnosis and management. The role of the dietitian is crucial to ensure that both the breastfeeding mother and infant avoid all the appropriate foods, but that their diet still contains all the nutrients needed.

Dr Carina Venter,
  Allergy Specialist
  Dietitian, Isle of Wight

Contact
  Nutricia Ltd, White Horse Business Park
  Trowbridge, Wiltshire BA14 0XQ
  Parent/Carer information number: 08457 623 653
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