What is the best formula for baby with milk allergy

With such a wide range of symptoms that can be caused by CMPA, the differential diagnosis is extensive, and includes other food allergies, non-food allergies such as pollen, animal dander, other gastrointestinal disorders, pancreatic insufficiency such as in cystic fibrosis, and infections — eg urinary tract infection.


Diagnosis[8]

Allergic reactions can be immunoglobulin E (IgE)-mediated reactions or non-IgE-mediated reactions.

Cow’s milk proteins can cause reactions of either type or both together, which can make them hard to diagnose.

IgE-mediated reactions

IgE-mediated reactions trigger histamine release and happen within two hours of milk being consumed. They include skin reactions such as itching, erythema, urticaria and acute angio-oedema, most commonly of the face. There can be abdominal symptoms such as colicky pain, nausea, vomiting and diarrhoea. Respiratory symptoms can be upper or lower respiratory tract: nasal itching, sneezing, rhinorrhoea, congestion, cough, chest tightness or wheeze.

It is extremely rare for cow’s milk to trigger an anaphylactic reaction.

Antihistamines can be used to treat the symptoms. Allergic reactions may be more severe in people with asthma, particularly if the asthma is poorly controlled[9].

This type of allergy can be diagnosed with a skin prick test or a blood test (specific IgE, previously known as RAST). If this type of allergy is suspected, refer the kid to a paediatrician who will arrange for the test to be done in hospital.

Non-IgE-mediated reactions

Non-IgE-mediated reactions happen hours or days after consuming milk.

Skin reactions such as atopic eczema are common, as well as itching and erythema. Abdominal symptoms include colicky pain (including infantile colic), reflux, blood or mucus in stools, constipation or diarrhoea. There may be lower respiratory tract symptoms such as cough, wheeze, breathlessness or chest tightness.The kid may be pale and tired, and growth may be faltering.

The best way to establish if cow’s milk is causing these symptoms is to exclude it from the diet. There should be an improvement in symptoms within two weeks.


Epidemiology[2, 3]

CMPA affects about 7% of formula-fed babies but only about 0.5% of exclusively breast-fed babies, who also tend to own milder reactions.

Exclusive breast-feeding may also protect babies from developing an allergy to cow’s milk protein after they are weaned[4].

There are a number of diverse proteins in cows milk: there are five protein components in each of the casein and whey fractions of milk. A kid can be allergic to one or more components within either group.

CMPA is more likely in children who own other atopic conditions such as asthma, eczema or hay fever, or if shut family members own those conditions. The presence of atopic eczema is a predictor for sensitisation to common food allergens. The earlier the eczema starts and the more severe it is, the higher the risk of food allergy[5].

If there are other food allergies, it is more likely that CMPA will persist into later childhood.

Some work has been done looking at the development of food allergies and whether this can be prevented by feeding infants at risk with hydrolysed formula.

However, the results own so far not been clear[6, 7].


Lactose intolerance[20]

Many people confuse lactose intolerance with CMPA.

Lactose intolerance is an inability to digest lactose, due to an inadequate production of the digestive enzyme lactase. It is generally a condition of older childhood and adulthood. Worldwide it is extremely common, although it is less prevalent in northern European races. It is unusual for babies and young children to be intolerant of lactose, although they do fairly commonly develop a transient lactose intolerance following an episode of gastroenteritis.

People with a lactose intolerance can often consume products such as yoghurt and cheese in which the lactose has been altered and they may be capable to own little amounts of milk without symptoms.

They can generally tolerate lactose-free milk.

Clinical Editor’s comments (October 2017)
Dr Hayley Willacy recommends the recently released international Milk Allergy in primary care guideline[1]. The guideline includes updated recommendations on presentation and recognition of cow’s milk allergy (CMA); diagnosis; management of mild-to-moderate confirmed non-IgE-mediated CMA within primary care; suspected severe non-IgE-mediated CMA and referral.

A number of additional resources own been developed alongside the guideline to support parents and carers, including an initial factsheet for parents; a home reintroduction protocol to confirm diagnosis; a milk ladder and milk ladder recipes.

Flu vaccination.
Protect yourself this autumn.

Find out if you are eligible for a free NHS flu vaccination.

Check eligibility

  • Boyano-Martinez T, Garcia-Ara C, Pedrosa M, et al; Accidental allergic reactions in children allergic to cow's milk proteins. J Allergy Clin Immunol.

    2009 Apr123(4):883-8. doi: 10.1016/j.jaci.2008.12.1125. Epub 2009 Feb 20.

  • Osborn DA, Sinn J; Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006 Oct 18(4):CD003664.

  • Hill DJ, Hosking CS; Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol. 2004 Oct15(5):421-7.

  • Yeung JP, Kloda LA, McDevitt J, et al; Oral immunotherapy for milk allergy. Cochrane Database Syst Rev.

    2012 Nov 1411:CD009542. doi: 10.1002/14651858.CD009542.pub2.

  • Agostoni C, Terracciano L, Varin E, et al; The Nutritional Worth of Protein-hydrolyzed Formulae. Crit Rev Food Sci Nutr. 201656(1):65-9. doi: 10.1080/10408398.2012.713047.

  • Miraglia Del Giudice M, D'Auria E, Peroni D, et al; Flavor, relative palatability and components of cow's milk hydrolysed formulas and amino acid-based formula. Ital J Pediatr. 2015 Jun 341:42. doi: 10.1186/s13052-015-0141-7.

  • The Milk Ladder; MAP Guideline

  • Host A, Halken S; Cow's milk allergy: where own we come from and where are we going? Endocr Metab Immune Disord Drug Targets. 2014 Mar14(1):2-8.

  • Vandenplas Y, Koletzko S, Isolauri E, et al; Guidelines for the diagnosis and management of cow's milk protein allergy in infants.

    Arch Dis Kid. 2007 Oct92(10):902-8.

  • Boyle RJ, Ierodiakonou D, Khan T, et al; Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ. 2016 Mar 8352:i974. doi: 10.1136/bmj.i974.

  • Cows milk protein allergy in children; NICE CKS, June 2015 (UK access only)

  • Ludman S, Shah N, Fox AT; Managing cows' milk allergy in children. BMJ. 2013 Sep 16347:f5424. doi: 10.1136/bmj.f5424.

  • Venter C, Brown T, Meyer R, et al; Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline.

    Clin Transl Allergy. 2017 Aug 237:26. doi: 10.1186/s13601-017-0162-y. eCollection 2017.

  • Leonard SA, Nowak-Wegrzyn AH; Baked Milk and Egg Diets for Milk and Egg Allergy Management. Immunol Allergy Clin North Am. 2016 Feb36(1):147-59. doi: 10.1016/j.iac.2015.08.013.

  • Liao SL, Lai SH, Yeh KW, et al; Exclusive breastfeeding is associated with reduced cow's milk sensitization in early childhood. Pediatr Allergy Immunol. 2014 Aug25(5):456-61. doi: 10.1111/pai.12247.

  • Dupont C, Hol J, Nieuwenhuis EE; An extensively hydrolysed casein-based formula for infants with cows' milk protein allergy: tolerance/hypo-allergenicity and growth catch-up.

    Br J Nutr. 2015 Apr 14113(7):1102-12. doi: 10.1017/S000711451500015X. Epub 2015 Mar 17.

  • Vandenplas Y, De Greef E, Devreker T; Treatment of Cow's Milk Protein Allergy. Pediatr Gastroenterol Hepatol Nutr. 2014 Mar17(1):1-5. doi: 10.5223/pghn.2014.17.1.1. Epub 2014 Mar 31.

  • Bloom KA, Huang FR, Bencharitiwong R, et al; Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol. 2014 Dec25(8):740-6. doi: 10.1111/pai.12283. Epub 2014 Dec 18.

  • Vandenplas Y; Lactose intolerance. Asia Pac J Clin Nutr. 201524 Suppl 1:S9-13. doi: 10.6133/apjcn.2015.24.s1.02.

APR. 11, 2018 2 MIN. READ

As a parent you always desire the best for your baby and that includes protecting them from anything unpleasant or harmful.

When repeated tummy troubles or other symptoms strike after feedings, you might be asking yourself: "Does my baby own a milk allergy?" It’s a reasonable concern and there are things you can do to hold your baby safe.

Jan Kajzer, MS, RD, LD, an Abbott pediatric nutrition researcher specializing in food allergies, shares what to glance for.

Spotting the Symptoms

Cow’s milk allergy symptoms can be as mild as a rash or a runny nose or they can be extremely dangerous. When you’re caring for an baby who can’t speak, trying to figure out if your kid is allergic to milk can be tricky. Knowing these common food allergy symptoms can help:

Another clue is timing.

Symptoms generally start to appear a few minutes to two hours after eating, so pay shut attention in the time directly after your baby eats to see if an allergy could be the problem.

Your Healthcare Provider Can Help

Cow’s milk allergy is most likely to develop during a baby’s first year. Because the incidence of food allergies is on the rise they’re on numerous parents’ radars. However, they can also be misdiagnosed by well-meaning parents trying to soothe an uncomfortable baby. That’s why it’s especially significant to speak to your baby’s doctor if you suspect a food allergy. They’ll be capable to do a full exam, take a history of every symptoms and even refer you to an allergist.

Download: My Child’s Symptom Diary Log

Feeding Your Baby

Even little amounts of milk can cause a reaction in a milk-allergic baby, and since there’s no cure for food allergies, parents need to make certain that their baby strictly avoids every milk and milk-containing foods.

If you’re breastfeeding, you may be advised to avoid these items as well since the proteins can be passed through breast milk.

For formula-fed babies, a doctor will likely propose a hypoallergenic formula where the protein has been extensively hydrolyzed or broken below such as Similac® Alimentum® . If the baby cannot tolerate the extensively hydrolyzed formula, you may be advised to use an amino acid-based formula, love EleCare. After baby’s first birthday, your doctor will recommend the best milk-free alternative beverage for your baby.

Milk allergies aren’t just about what’s in your baby’s bottle. If your kid has started eating solid food, you’ll also need to make certain that they avoid every milk-containing foods such as yogurt or cheese.

Because milk can be in numerous foods, your baby’s doctor may also refer you to a registered dietitian to assist you study to glance for problem ingredients.

Communicating With Caregivers

If you’re love numerous parents, you may not be the only person who feeds your baby, and educating anyone who cares for them is critical. If a grandparent or babysitter is routinely responsible for your kid, it can be helpful to invite them to join you when you visit the doctor or dietitian.

For kids who go to daycare, you may desire to schedule a time to sit below with the center’s istrator to discuss your child’s diagnosis as well as milk avoidance strategies. Numerous daycare centers own experience dealing with food allergies and own policies in put to ensure that your baby is protected from any exposure to milk.

Managing a milk allergy can be daunting but with the correct support and resources you can protect your baby and ensure they get the needed nutrients to grow strong and healthy.

1.

Lifschitz C, Szajewska H. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur. J.

What is the best formula for baby with milk allergy

Pediatr. 2015 Feb;174(2):141-50. [ PubMed: 25257836]

2.

Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, Sundaram V, Paige NM, Towfigh A, Hulley BJ, Shekelle PG. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010 May 12;303(18):1848-56. [ PubMed: 20460624]

3.

Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C. The prevalence of food allergy: a meta-analysis. J. Allergy Clin. Immunol. 2007 Sep;120(3):638-46.

[ PubMed: 17628647]

4.

Høst A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13(s15):23-8. [ PubMed: 12688620]

5.

Wood RA, Sicherer SH, Vickery BP, Jones SM, Liu AH, Fleischer DM, Henning AK, Mayer L, Burks AW, Grishin A, Stablein D, Sampson HA. The natural history of milk allergy in an observational cohort.

J. Allergy Clin. Immunol. 2013 Mar;131(3):805-12. [ PubMed: 23273958]

6.

Bartuzi Z, Cocco RR, Muraro A, Nowak-Węgrzyn A. Contribution of Molecular Allergen Analysis in Diagnosis of Milk Allergy. Curr Allergy Asthma Rep. 2017 Jul;17(7):46. [ PubMed: 28597347]

7.

Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM., NIAID-Sponsored Expert Panel.

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J. Allergy Clin. Immunol. 2010 Dec;126(6):1105-18. [ PubMed: 21134568]

8.

Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P., EWGPAG. Cow’s milk protein allergy in children: a practical guide. Ital J Pediatr. 2010 Jan 15;36:5. [ PubMed: 20205781]

9.

Kansu A, Yüce A, Dalgıç B, Şekerel BE, Çullu-Çokuğraş F, Çokuğraş H. Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey.

Turk. J. Pediatr. 2016;58(1):1-11. [ PubMed: 27922230]

10.

Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT., Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin. Exp. Allergy. 2014;44(5):642-72. [ PubMed: 24588904]

11.

Martorell A, Plaza AM, Boné J, Nevot S, García Ara MC, Echeverria L, Alonso E, Garde J, Vila B, Alvaro M, Tauler E, Hernando V, Fernández M.

Cow’s milk protein allergy. A multi-centre study: clinical and epidemiological aspects. Allergol Immunopathol (Madr) 2006 Mar-Apr;34(2):46-53. [ PubMed: 16606545]

12.

Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, La Grutta S, Panetta V, Verga MC, Calvani M. Specific IgE and skin prick tests to diagnose allergy to unused and baked cow’s milk according to age: a systematic review. Ital J Pediatr. 2017 Oct 12;43(1):93. [ PubMed: 29025431]

13.

Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G.

Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr. 2018 Jul 17;44(1):82. [ PubMed: 30016966]

14.

Caffarelli C, Ricò S, Rinaldi L, Povesi Dascola C, Terzi C, Bernasconi S.

What is the best formula for baby with milk allergy

Blood pressure monitoring in children undergoing food challenge: association with anaphylaxis. Ann. Allergy Asthma Immunol. 2012 Apr;108(4):285-6. [ PubMed: 22469454]

15.

Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y., European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J. Pediatr. Gastroenterol. Nutr. 2012 Aug;55(2):221-9. [ PubMed: 22569527]

16.

Pensabene L, Salvatore S, D’Auria E, Parisi F, Concolino D, Borrelli O, Thapar N, Staiano A, Vandenplas Y, Saps M.

Cow’s Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Nutrients. 2018 Nov 09;10(11) [ PubMed: 30423934]

17.

Høst A. Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol. 1994;5(5 Suppl):1-36. [ PubMed: 7704117]

18.

Host A, Halken S. Cow’s milk allergy: where own we come from and where are we going?

Endocr Metab Immune Disord Drug Targets. 2014 Mar;14(1):2-8. [ PubMed: 24450456]

19.

Restani P, Gaiaschi A, Plebani A, Beretta B, Cavagni G, Fiocchi A, Poiesi C, Velonà T, Ugazio AG, Galli CL. Cross-reactivity between milk proteins from diverse animal species. Clin. Exp. Allergy. 1999 Jul;29(7):997-1004. [ PubMed: 10383602]

20.

Yue D, Ciccolini A, Avilla E, Waserman S.

Food allergy and anaphylaxis. J Asthma Allergy. 2018;11:111-120. [ PubMed: 29950871]

21.

Anagnostou K. Anaphylaxis in Children: Epidemiology, Risk Factors and Management. Curr Pediatr Rev. 2018;14(3):180-186. [ PubMed: 29732976]

22.

Høst A. Frequency of cow’s milk allergy in childhood. Ann. Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):33-7. [ PubMed: 12487202]

23.

Oranje AP, Wolkerstorfer A, de Waard-van der Spek FB.

Natural course of cow’s milk allergy in childhood atopic eczema/dermatitis syndrome. Ann. Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):52-5. [ PubMed: 12487205]

Why should I wait until my baby is at least 12 months ancient to introduce cow’s milk?

Babies can’t digest cow’s milk as completely or easily as breast milk or formula. Cow’s milk contains high concentrations of protein and minerals, which can tax your baby’s immature kidneys.

Cow’s milk doesn’t own the correct amounts of iron, vitamin C, and other nutrients for infants. It may even cause iron-deficiency anemia in some babies, since cow’s milk protein can irritate the lining of the digestive system, leading to blood in the stools.

Finally, cow’s milk doesn’t provide the healthiest types of fat for growing babies.

However, once your child’s ready to digest it, dairy milk can supplement a balanced diet of solid foods that include cereals, vegetables, fruits and meats.

APR. 11, 2018 2 MIN.

What is the best formula for baby with milk allergy

READ

As a parent you always desire the best for your baby and that includes protecting them from anything unpleasant or harmful. When repeated tummy troubles or other symptoms strike after feedings, you might be asking yourself: "Does my baby own a milk allergy?" It’s a reasonable concern and there are things you can do to hold your baby safe.

Jan Kajzer, MS, RD, LD, an Abbott pediatric nutrition researcher specializing in food allergies, shares what to glance for.

Spotting the Symptoms

Cow’s milk allergy symptoms can be as mild as a rash or a runny nose or they can be extremely dangerous.

When you’re caring for an baby who can’t speak, trying to figure out if your kid is allergic to milk can be tricky. Knowing these common food allergy symptoms can help:

Another clue is timing. Symptoms generally start to appear a few minutes to two hours after eating, so pay shut attention in the time directly after your baby eats to see if an allergy could be the problem.

Your Healthcare Provider Can Help

Cow’s milk allergy is most likely to develop during a baby’s first year. Because the incidence of food allergies is on the rise they’re on numerous parents’ radars.

However, they can also be misdiagnosed by well-meaning parents trying to soothe an uncomfortable baby. That’s why it’s especially significant to speak to your baby’s doctor if you suspect a food allergy. They’ll be capable to do a full exam, take a history of every symptoms and even refer you to an allergist.

Download: My Child’s Symptom Diary Log

Feeding Your Baby

Even little amounts of milk can cause a reaction in a milk-allergic baby, and since there’s no cure for food allergies, parents need to make certain that their baby strictly avoids every milk and milk-containing foods.

If you’re breastfeeding, you may be advised to avoid these items as well since the proteins can be passed through breast milk.

For formula-fed babies, a doctor will likely propose a hypoallergenic formula where the protein has been extensively hydrolyzed or broken below such as Similac® Alimentum® . If the baby cannot tolerate the extensively hydrolyzed formula, you may be advised to use an amino acid-based formula, love EleCare. After baby’s first birthday, your doctor will recommend the best milk-free alternative beverage for your baby.

Milk allergies aren’t just about what’s in your baby’s bottle.

If your kid has started eating solid food, you’ll also need to make certain that they avoid every milk-containing foods such as yogurt or cheese. Because milk can be in numerous foods, your baby’s doctor may also refer you to a registered dietitian to assist you study to glance for problem ingredients.

Communicating With Caregivers

If you’re love numerous parents, you may not be the only person who feeds your baby, and educating anyone who cares for them is critical. If a grandparent or babysitter is routinely responsible for your kid, it can be helpful to invite them to join you when you visit the doctor or dietitian. For kids who go to daycare, you may desire to schedule a time to sit below with the center’s istrator to discuss your child’s diagnosis as well as milk avoidance strategies.

Numerous daycare centers own experience dealing with food allergies and own policies in put to ensure that your baby is protected from any exposure to milk.

Managing a milk allergy can be daunting but with the correct support and resources you can protect your baby and ensure they get the needed nutrients to grow strong and healthy.

1.

Lifschitz C, Szajewska H. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur. J. Pediatr.

2015 Feb;174(2):141-50. [ PubMed: 25257836]

2.

Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, Sundaram V, Paige NM, Towfigh A, Hulley BJ, Shekelle PG. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010 May 12;303(18):1848-56. [ PubMed: 20460624]

3.

Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C. The prevalence of food allergy: a meta-analysis. J. Allergy Clin. Immunol. 2007 Sep;120(3):638-46. [ PubMed: 17628647]

4.

Høst A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13(s15):23-8. [ PubMed: 12688620]

5.

Wood RA, Sicherer SH, Vickery BP, Jones SM, Liu AH, Fleischer DM, Henning AK, Mayer L, Burks AW, Grishin A, Stablein D, Sampson HA. The natural history of milk allergy in an observational cohort. J. Allergy Clin. Immunol. 2013 Mar;131(3):805-12. [ PubMed: 23273958]

6.

Bartuzi Z, Cocco RR, Muraro A, Nowak-Węgrzyn A. Contribution of Molecular Allergen Analysis in Diagnosis of Milk Allergy.

Curr Allergy Asthma Rep. 2017 Jul;17(7):46. [ PubMed: 28597347]

7.

Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM., NIAID-Sponsored Expert Panel. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J. Allergy Clin. Immunol.

2010 Dec;126(6):1105-18. [ PubMed: 21134568]

8.

What is the best formula for baby with milk allergy

Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P., EWGPAG. Cow’s milk protein allergy in children: a practical guide. Ital J Pediatr. 2010 Jan 15;36:5. [ PubMed: 20205781]

9.

Kansu A, Yüce A, Dalgıç B, Şekerel BE, Çullu-Çokuğraş F, Çokuğraş H. Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turk. J. Pediatr. 2016;58(1):1-11. [ PubMed: 27922230]

10.

Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT., Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) BSACI guideline for the diagnosis and management of cow’s milk allergy.

Clin. Exp. Allergy. 2014;44(5):642-72. [ PubMed: 24588904]

11.

Martorell A, Plaza AM, Boné J, Nevot S, García Ara MC, Echeverria L, Alonso E, Garde J, Vila B, Alvaro M, Tauler E, Hernando V, Fernández M. Cow’s milk protein allergy. A multi-centre study: clinical and epidemiological aspects. Allergol Immunopathol (Madr) 2006 Mar-Apr;34(2):46-53. [ PubMed: 16606545]

12.

Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, La Grutta S, Panetta V, Verga MC, Calvani M. Specific IgE and skin prick tests to diagnose allergy to unused and baked cow’s milk according to age: a systematic review.

Ital J Pediatr. 2017 Oct 12;43(1):93. [ PubMed: 29025431]

13.

Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G. Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr. 2018 Jul 17;44(1):82. [ PubMed: 30016966]

14.

Caffarelli C, Ricò S, Rinaldi L, Povesi Dascola C, Terzi C, Bernasconi S.

Blood pressure monitoring in children undergoing food challenge: association with anaphylaxis. Ann. Allergy Asthma Immunol. 2012 Apr;108(4):285-6. [ PubMed: 22469454]

15.

What is the best formula for baby with milk allergy

Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y., European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines.

What is the best formula for baby with milk allergy

J. Pediatr. Gastroenterol. Nutr. 2012 Aug;55(2):221-9. [ PubMed: 22569527]

16.

Pensabene L, Salvatore S, D’Auria E, Parisi F, Concolino D, Borrelli O, Thapar N, Staiano A, Vandenplas Y, Saps M. Cow’s Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Nutrients. 2018 Nov 09;10(11) [ PubMed: 30423934]

17.

Høst A. Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol. 1994;5(5 Suppl):1-36. [ PubMed: 7704117]

18.

Host A, Halken S. Cow’s milk allergy: where own we come from and where are we going?

Endocr Metab Immune Disord Drug Targets. 2014 Mar;14(1):2-8. [ PubMed: 24450456]

19.

Restani P, Gaiaschi A, Plebani A, Beretta B, Cavagni G, Fiocchi A, Poiesi C, Velonà T, Ugazio AG, Galli CL. Cross-reactivity between milk proteins from diverse animal species. Clin. Exp. Allergy. 1999 Jul;29(7):997-1004. [ PubMed: 10383602]

20.

Yue D, Ciccolini A, Avilla E, Waserman S. Food allergy and anaphylaxis. J Asthma Allergy. 2018;11:111-120. [ PubMed: 29950871]

21.

Anagnostou K. Anaphylaxis in Children: Epidemiology, Risk Factors and Management. Curr Pediatr Rev. 2018;14(3):180-186. [ PubMed: 29732976]

22.

What is the best formula for baby with milk allergy

Høst A. Frequency of cow’s milk allergy in childhood. Ann. Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):33-7. [ PubMed: 12487202]

23.

Oranje AP, Wolkerstorfer A, de Waard-van der Spek FB. Natural course of cow’s milk allergy in childhood atopic eczema/dermatitis syndrome. Ann. Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):52-5. [ PubMed: 12487205]

Why should I wait until my baby is at least 12 months ancient to introduce cow’s milk?

Babies can’t digest cow’s milk as completely or easily as breast milk or formula. Cow’s milk contains high concentrations of protein and minerals, which can tax your baby’s immature kidneys.

Cow’s milk doesn’t own the correct amounts of iron, vitamin C, and other nutrients for infants.

It may even cause iron-deficiency anemia in some babies, since cow’s milk protein can irritate the lining of the digestive system, leading to blood in the stools. Finally, cow’s milk doesn’t provide the healthiest types of fat for growing babies.

However, once your child’s ready to digest it, dairy milk can supplement a balanced diet of solid foods that include cereals, vegetables, fruits and meats.


Why should my kid start drinking cow’s milk?

Milk is a wealthy source of calcium, which builds strong bones and teeth and helps regulate blood clotting and muscle control.

It’s also one of the few sources of vitamin D, which helps the body absorb calcium and is crucial for bone growth. (Almost every milk in the United States is fortified with vitamin D.)

Milk also provides protein for growth, and carbohydrates to give your kid the energy he needs every day. And if your kid gets enough calcium from the get-go, there’s evidence that he’ll own a lower risk of high blood pressure, stroke, colon cancer, and hip fractures later in life.


Management [10]

Challenge test

The prognosis of CMPA is excellent with a remission rate of approximately 45-50% at 1 year, 60-75% at 2 years and 85-90% at 3 years[15].Children can own a challenge test every 6-12 months to see if they are capable to tolerate milk.

It may take several days for the reaction to show, particularly for non-IgE allergy.

The challenge test can be carried out in stages, according to the ‘Milk Ladder’[16]. This is a hierarchy of milk-containing foods, beginning with those least likely to cause a reaction and gradually moving towards being capable to drink a glass of milk. In baked form, such as muffins, cakes or malted milk biscuits, cow’s milk is less allergenic and may be tolerated sooner than unbaked milk. There is some evidence that including cooked milk in the diet may hasten the resolution of allergy to non-cooked milk[17, 18].

If the kid has had IgE type reactions, particularly if they own been severe, then a challenge test should be carried out under shut supervision.

Allergen avoidance

The management of CMPA generally consists of avoidance of the allergen.

If CMPA is the cause of the symptoms then they should resolve within two weeks of stopping cow’s milk.

If the kid is formula-fed, they can be given extensively hydrolysed milk formula such as Nutramigen®, Aptamil Pepti® or Pepti Junior®. These are based on cow’s milk but the proteins are broken below into smaller peptides that are less likely to trigger an allergic reaction.

Babies who own CMPA may own their growth and development impaired by the disorder; however, hydrolysed formula is shown to provide balanced nutrition and to restore normal growth and development[12, 13].

If the symptoms persist on hydrolysed formula but a suspicion of CMPA remains, then attempt an amino acid formula.

These include Nutramigen AA® and Neocate LCP®. Hydrolysed milks are cheaper and are also generally better tolerated, although the flavour and tolerability varies[14].

If the kid is breast-fed and the mom wishes to continue breast-feeding, she must eliminate milk and milk products from her diet. This will include checking ingredients for anything derived from milk, such as casein, whey and lactose. The mom should make certain she is still getting adequate calcium in her diet. It is recommended that she be offered calcium and vitamin D tablets; however, calcium can also come from tinned fish, pulses, almonds, kale, oranges and soya products such as soya milk and tofu[8].

Babies who are being weaned, and older children with persisting CMPA, will need to follow a cow’s milk-free diet as above.

Parents must be advised about how to check the ingredients of processed foods for milk-derived constituents. Children should be referred to a paediatric dietician for advice about maintaining a balanced diet while excluding allergens.

Alternative milks

Soya formulas own been prescribed in the past for CMPA but soya is also a common allergen, so this is no longer routinely advised. About 10-15% of children allergic to cow’s milk will also react to soya. Soya milk also contains isoflavones which own a feeble oestrogenic activity.

Other milks, such as pea, oat or coconut, may be used after the age of 2 years, depending on the child’s nutritional status and any other allergies they may own.

A brand fortified with calcium should be used if available. Rice milk is not recommended for children aged under 4.5 years.

If the symptoms of CMPA persist into older childhood or beyond then patients need to continue to avoid milk and milk products. The proteins in goat’s milk and other mammal milks which may be available are almost identical to those found in cow’s milk, so those are not suitable substitutes. It is significant to maintain an adequate calcium intake. Children who are avoiding cow’s milk for allergy reasons should be referred to a paediatric dietician for specialist advice.

New treatments

Immunotherapy, in which children are given a gradually increasing dose of milk over a period of several months, is one option which has been tried for children with persisting severe allergy.

The results own been extremely promising, although a Cochrane review concluded that further studies of higher quality were necessary before it can be recommended without reservation[19].


RELATED VIDEO: