Cows' milk allergy (CMA) is a reaction to cows' milk that results from a hypersensitive immune response to one or more milk proteins. Symptoms of cows' milk allergy can be skin rash, wheezing, vomiting, diarrhoea, constipation and distress.

Milk is the most common cause of food allergy, affecting a minimum of 2-3% of infants. In the UK, at least 10,000 babies will be affected. However symptoms suggestive of cows' milk allergy may be present in up to 15% of babies, which means that 50,000 babies in the UK may have some symptoms of CMA. This highlights the importance of ensuring that key healthcare professionals (such as GPs, health visitors and paediatricians) know how to recognise the symptoms and how to diagnose and manage the condition.

Allergy or intolerance?

Lactose intolerance should not be confused with milk allergy.

A food allergy, such as cows' milk allergy, involves a reaction, immediate or delayed, of the immune system to the protein in a particular food.

Food intolerance differs in that the reaction does not involve an immune response. For example lactose intolerance occurs because of the body's inability to break down the lactose in milk, causing bloating, abdominal pain and diarrhoea.

Common food allergens
Most food allergy occurs in the first two years of life. Common food allergens include:

cows' milk

soy

egg

peanuts and tree nuts

wheat

fish and shellfish.

Although uncommon, even babies fed solely on breast milk* may react against food proteins from the mother's diet which can find their way into her milk.

In rare cases, babies suffer allergic reactions despite being breastfed. These are not reactions to the breast milk itself - they are reactions to proteins from the mother's diet passing into the milk. It is possible to control these symptoms whilst continuing to breastfeed but seek medical attention. DO NOT stop breastfeeding without careful consideration of the social, nutritional and financial implications, as it may be difficult to reverse this decision. DO NOT restrict the mother's diet, unless under the supervision of a dietician, as over-restriction of the mother's diet may be harmful to mother and child.

Most milk allergies in children disappear by the age of 3-5 years old whereas some allergies (e.g. nuts) tend to last for life.

Symptoms of cows' milk allergy
Most babies with cows' milk allergy develop symptoms within the first few months of life. It is rare for symptoms to begin after the age of 12 months.

Most babies with cows' milk allergy will have two or more symptoms:

50-70% have skin symptoms, eg. eczema

50-60% have stomach/gut symptoms, eg. vomiting

20-30% have breathing symptoms, eg. wheezing.

Obtaining a diagnosis
It is important to obtain a correct diagnosis for milk allergy. Parents should consult a GP if milk allergy is suspected and request a referral to a specialist (e.g. Paediatric Allergy Specialist) if appropriate.

Management of cows' milk allergy
The recommended management approach to cows' milk allergy is to completely avoid cows' milk protein. Milk is an important food for infants, so cutting it out from a baby's diet may put them at risk of poor growth. If a milk allergy is diagnosed, the healthcare professional can prescribe a hypoallergenic formula, such as an amino-acid based formula (AAF) or an extensively hydrolysed formula (eHF), that is easy to use, palatable, will provide rapid relief of symptoms and enables optimal growth and development.

Formulas not suitable for the management of cows' milk allergy

Soy

Soy-based infant formulas should not be used for the dietary management of milk allergy in infants under the age of six months.,. According to an independent scientific committee that advises the Department of Health, soy-based infant formulas are not routinely recommended because of the high content of phytoestrogens (compounds that mimic the action of the female hormone oestrogen) found in soy, which could pose a risk to the long-term reproductive health of infants,. There is also cross-reactivity between cows' milk protein and soy protein, which means that some infants allergic to cows' milk will also be allergic to soy.

Sheep and Goat's milk
Sheep's milk and goats' milk are not suitable for the dietary management of milk allergies these can also cause an allergic reaction in infants with cows' milk allergy.

Partially hydrolysed formula also has no role in the management of milk allergy as they contain intact proteins which can trigger allergic reactions.

'Milks' based on cereals, grains and legumes (e.g. oat milk, rice milk, pea milk) are unsuitable for infants with milk allergy because they are nutritionally inadequate.

News About Cows' Milk Allergy Here

June 2007

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