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Cows' Milk Allergy - Facts versus Fiction

Cows' milk allergy (CMA) - as for many medical conditions that affect infants and children - can be the source of stress and worry for their parents, who are searching for the truth about diagnosis, treatment and long-term prognosis.

Lack of awareness and old wives' tales can all create an environment of confusion. Here, we'd like to help you to separate the facts from the fiction about CMA.
Fiction "CMA only affects the baby with the condition."
Fact CMA not only has a debilitating effect on the sufferer, with symptoms including vomiting, diarrhoea, failure to thrive and eczema, it also has a secondary impact on the parents and other siblings, which include: loss of sleep, arguments with their partner, absence from work and lack of attention to other children in the family.*

Fiction "CMA is extremely rare."
Fact Cows' milk is the most common cause of food allergy in infants and children, affecting at least 10,000 infants in the UK. 10,000 is a modest figure because the potential for under diagnosis suggests that the actual number of cases of infant CMA likely exceeds the number of documented cases.

Fiction "CMA is just a more serious case of lactose intolerance"
Fact Lactose intolerance and CMA are two different things, affecting the body in different ways.

Lactose intolerance is the inability to digest significant amounts of lactose (a sugar found in milk) due to a shortage of the enzyme lactase. The main symptoms are bloating, wind and nausea.5

A true cows' milk allergy, however, occurs when the immune system abnormally reacts to one or more of the proteins found in milk, as though they were a harmful body. It presents in one or more of three organ systems:
Bullet  Gastrointestinal (vomiting, diarrhoea, abdominal cramps, bloating) – affecting 50-60% of those with CMA
Bullet  Skin (rashes, including eczema and atopic dermatitis) – 50-70%
Bullet  Respiratory (wheeze, cough, runny nose) – 20-30%6

Fiction "CMA is easily diagnosed by GPs."
Fact The variety of symptom combinations and time to onset make CMA troublesome to diagnose, including the risk of treating individual symptoms (skin or stomach problems) without establishing a proper CMA diagnosis. 4 out of 5 doctors confuse milk allergy symptoms with other conditions such as gastroenteritis and colic.

Fiction A child can only develop it if one of its parents has the condition."
Fact Children do not have to have a parent with CMA to develop the condition themselves. Although risk increases with the number of first-degree family members affected by an allergic disease, there's a 10-15% chance that a child with no family history of allergy can still develop the condition. Other factors that increase the risk of allergy development include atopic conditions such as asthma and eczema, the environment, exposure to allergens and immunity status.

Fiction "A child's diet will be compromised by a CMA, causing long-term health problems"
Fact If a prompt diagnosis is made and effective treatment, e.g. suitable alternative hypoallergenic formula milk, introduced quickly into the diet, a child with CMA can thrive as normal. Under the supervision of a medical professional, the essential vitamins, minerals and proteins provided by cows' milk can be substituted to ensure a perfectly nutritious and balanced diet. However, it is important to act quickly if a case of CMA is suspected and to seek proper medical attention, since some commonly-available off-the-shelf milk alternatives are not recommended in young children e.g. soya, goats', sheep or rice milks.

Fiction "People with CMA can use soya, goats' or sheep's milks as suitable alternatives to cows' milk"
Fact Many people with CMA will find that they are also allergic to soya, goats' and sheep milks. None of these cows' milk alternatives are recommended as the main source of nutrition for young infants because they contain a lower nutritional content not equivalent to breast or cows' milk. A knowledgeable medical professional will be able to provide advice about suitable hypoallergenic formula that is easy to use, palatable, will provide rapid relief of symptoms and enable optimal growth and development.

Fiction "Cows' milk allergy is for life"
Fact The vast majority of infants (>95%) will outgrow CMA by the age of 3-5 years.
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