Positive outcomes for cow’s milk allergy is the 4th in the 5-part blog series on Cow’s Milk Allergy in Infancy and is best read following treatment options for cow’s milk allergy.
Around 50% of infants with non-IgE Cow’s Milk Allergy tolerate milk by age 1. Positive outcomes for Cow’s Milk Allergy depend on a number of factors including the type and severity of symptoms; the length of time taken to confirm a diagnosis; and the infants ability to tolerate exposure to baked and fermented milk. Good ongoing dietary management and support, helps those positive outcomes for cow’s milk firstly by ensuring symptoms are settled and supported with a milk free diet whilst breastfeeding or with the most suitable formula. Mum and baby can then develop confidence with feeding; mum managing the learning curve of a cow’s milk free diet, and baby learning that feeding doesn’t hurt.
Active Allergy Management
Only once there are no residual symptoms for at least 3 months exposure maybe considered; firstly to small amounts of baked milk and then fermented milk or yoghurt. Active Allergy Management involves the deliberate introduction of small amounts of milk proteins at the right time. This helps to educate the immune system and develop tolerance. Acquiring tolerance in this way speeds up the return to a normal diet. Considerations then:
Type and severity of symptoms
Infants with severe or immediate reactions (IgE) take longer to out grow their allergy. Those infants should not consume cow’s milk products within the first year after diagnosis, although 75% can tolerate small amounts of yoghurt by age 2. For delayed reactions (non-IgE) such as reflux – see identifying symptoms of cow’s milk allergy most infants (>50%) have outgrown their allergy by their first birthday.
Length of time taken to confirm a diagnosis
In a 2015 survey, the average length of time taken to confirm a diagnosis was 4-5 weeks and 10 GP visits. I am now seeing infants at a much earlier stage, due mainly to increased awareness in GP’s and in families. Early intervention is the key to seeing those positive outcomes for cow’s milk allergy at an earlier stage. In general, the longer it takes to identify symptoms, and confirm a diagnosis the longer it will take to acquire tolerance.
Ability to tolerate exposure to baked and fermented cow’s milk
Exposure and tolerance to baked and fermented cow’s milk, with the use of the Milk Ladder has seen more positive outcomes for cow’s milk allergy at an earlier stage. The Milk Ladder provides evidence based stepwise reintroduction of milk products; which can usually begin around 9 months of age. The latest version is available to download from the Allergy UK website.
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