Cow’s Milk Allergy affects 1 in 20 babies in their first year.  Symptoms or reactions develop when a baby’s immune system reacts to proteins found in cow’s milk. Cow’s Milk Allergy (CMA) presents when changing from breastmilk to formula or when solids containing milk are given during weaning. Breast fed babies can also have CMA, when milk proteins from mum’s diet are transferred to the baby in mums milk.  Reactions can either be immediate or delayed and symptoms vary from mild-moderate to severe and persisting. The timing of the onset of symptoms provides a useful indicator of the type of CMA and dietary treatment needed.

Cow’s Milk Allergy reactions and symptoms

Food allergy is an atopic and multi-system condition. Both immediate and delayed types of CMA are more common in atopic families: those with a history of asthma, eczema and hayfever.  The most common food allergen in infancy, CMA is implicated in atopic eczema that’s unresponsive to treatment. Delayed reactions involve tummy symptoms: loose, smelly, bloody or mucousy poohs, constipation and painful wind. At the upper end, vomiting after feeds, feeding difficulties, refusal and growth faltering. Babies are generally unsettled, sleeping and feeding disturbed. At least two persistent symptoms with delayed reactions are needed to consider a diagnosis alongside an allergy focused history.  Immediate reactions happen within minutes of exposure to cow’s milk. Reactions are more severe, and involve skin and/or respiratory symptoms and sometimes tummy (GI) symptoms. Any swelling around the face/mouth/eyes needs immediate medical attention. Oral anti-histamine syrup can be helpful (whilst waiting for emergency services vies) and adrenalin maybe required. Babies who have those types of reactions should have access to a Specialist Allergy Team, including a Paediatric Dietitan.

Dietary treatment for Cow’s Milk Allergy

The symptoms of CMA are resolved by the complete exclusion of cow’s milk and its products, for between 6 months for delayed reactions and up to 2 years for those with immediate reactions.  This is also the case for breast-feeding babies – mum’s need to follow an milk exclusion too, and should take a daily supplement of 1000mg calcium and 10-25ug Vitamin D.  Avoiding cow’s milk formula, cheese, yoghurt, dairy fats means that good non-dairy sources of calcium are a high priority for weaning infants. Infants needs for calcium are around 500mg, very high for their small size, and essential for the rapid bone growth at 6-12 months.  Your GP is your first point of contact for both types of CMA.  For ongoing concerns about growth or remaining symptoms a Paediatrician can provide a medical review.  Paediatric Dietitian’s are skilled in this area and provide dietary education, advise on nutritional needs for feeding mums and baby pairs, calcium and weaning needs on dairy free diets, suitable formulae and consideration of reintroduction of milk.

What about lactose intolerance?

Lactose intolerance is a different condition which is sometimes confused with CMA. It is best described as a digestive problem, due to insufficient digestive enzyme lactase.  Find out more about the difference between lactose intolerance and cow’s milk allergy.