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Cow's milk allergy (CMA) is the most common food allergy in infants and young children, affecting about one in 50 Australian infants.
It's not fully understood why the immune systems of these youngsters react against the proteins found in cow's milk, but due to the frequency of the condition, there's plenty of excellent medical help and advice for families affected by CMA. The best news is that most children outgrow this allergy by the age of three to five years and experience no CMA symptoms at all in later life.
Allergy – or intolerance?
An allergy is your immune system's haywire reaction to a food protein. Your body believes that the food protein is harmful, and mounts a counter-attack resulting in a multitude of unpleasant, even dangerous symptoms. The most extreme is anaphylaxis, a whole-body reaction which can be fatal.
Lactose intolerance doesn't involve the immune system at all. Instead, your body simply can't digest lactose and will tell you so via a number of uncomfortable symptoms: bloating, flatulence, stomach pains and other digestive disruptions. While certainly troublesome, these are not allergic reactions.
The symptoms of CMA
There are two types of cow's milk allergy: IgE-mediated and non-IgE-mediated. Symptoms and diagnosis vary between the two, and your doctor's first step will be to discover which type of CMA is affecting your little one.
In IgE-mediated CMA, the immune system reacts to proteins in cow's milk by producing igE antibodies, which in turn cause an allergic reaction with symptoms appearing very quickly – often within minutes and up to within two hours of contact with the allergen.
You might see skin symptoms such as itchy rash, eczema, hives or swelling of the face, mouth and tongue; gastrointestinal symptoms such as stomach pain, colic, vomiting and diarrhoea, or respiratory symptoms such as breathing difficulties, sneezing, nasal irritation and runny or blocked nose.
Symptoms of non-IgE-mediated CMA appear hours and sometimes even days after contact with cow's milk. They can be similar to the symptoms above, but might be less obvious and harder to immediately connect to the allergen due to the delay in appearance.
It's important to remember there is no definitive list of symptoms for either type of CMA, and many other conditions can look a lot like it. If your little one seems unwell, see your doctor as soon as possible to seek answers.
What happens next?
If symptoms suggest that your youngster might have a CMA, your
doctor will undertake certain tests.
Professor Katie Allen, paediatric gastroenterologist and allergist and associate Professor at the University of Melbourne and Murdoch Children's Research Institute, says:
"IgE-mediated CMA is easily diagnosed by clinicians because we have excellent diagnostic tests that are highly reliable. The way to test for the IgE antibody is either through skin prick testing or through a blood test."
She adds: "Skin prick testing is a simple procedure where a drop of the allergen of interest is placed on the child's arm or back and introduced into the skin through a small scratch."
If IgE antibodies are present, they will cause irritation, suggesting an IgE-mediated CMA.
Non-IgE-mediated CMA, with vaguer symptoms and delayed reactions, is a tougher challenge for doctors. Often, they'll eliminate cow's milk from the child's diet – usually for about two weeks - and then reintroduce it. If a CMA is present, the improvement in a child's wellbeing during the elimination phase is noticeable, and the symptoms return with the reintroduction of the cow's milk. Says Professor Allen: "Sometimes just one day [of reintroducing milk] is enough to let them know that we have scientific evidence that their child has had a reaction to the cow's milk protein."
Managing CMA
If you're breastfeeding a baby with CMA, your doctor will advise you to eliminate all cow's milk proteins from your own diet, to avoid passing them on through your breast milk. You can seek help from an accredited dietitian to ensure your diet contains all the required nutrients for you and your baby.
Your doctor and dietitian will also help you find substitutes for cow's milk proteins in the diet of toddlers and older children with CMA.
For formula-fed infants with CMA, there is a range of formulae available including those containing extensively hydrolysed cow's milk, formulae with amino acid, and soy-based formulae. Be aware that some infants with cow's milk allergy are also allergic to soy milk, and that many health bodies, including the American Academy of Paediatrics and the UK's Chief Medical Officer, do not recommend soya products for children under six months. Again, speak to your doctor about the best option for your infant.
Keeping safe
Avoiding products containing cow's milk can be challenging. In Australia and New Zealand any foods containing cow's milk in any form must list it in the ingredient list, but unexpected milk proteins could be present in many other situations, especially at fresh food outlets where food containing milk proteins is prepared on the same surfaces or with the same utensils as those without.
Daunting though it may seem, CMA is familiar territory now for most doctors and once you and your child have the support of a medical specialist, the journey will be much smoother.
Says Professor Katie Allen: "Your discussion with your treating physician should be an open communication, you should feel comfortable to ask any question on what the evidence is behind the recommendation that's being made. To be a partnership with your doctor about how to manage, diagnose and then hopefully grow out of this condition is the ultimate aim for all parents - and clinicians as well."
Fact Sheets on milk allergy are available from the Children's Hospital at Westmead and ASCIA websites.
Allerpro toddler milks have been formulated for children who are allergic to cows' milk protein. To help you assess if your child has cows' milk allergy, prior to seeking the advice of a healthcare professional, visit our symptom checker here.