What to give toddler with milk protein allergy
Sheet final reviewed: 12 July 2019
Next review due: 12 July 2022
What is cow’s milk protein allergy?
Cow’s milk protein allergy is an allergic condition which is triggered by drinking cow’s milk or by drinking or eating products made from cow’s milk.
It can cause:
- Gut (digestive tract) symptoms, such as feeling ill (nausea), being ill (vomiting) and abdominal (tummy) pain
- Skin symptoms, such as rashes and eczema
- Breathing (respiratory) symptoms, such as a runny nose and wheezing.
The symptoms are often vague and sometimes it is extremely hard for a definite diagnosis to be made.
Cow’s milk protein allergy occurs in about 7% of babies who own formula milk, but in only about 0.5% of exclusively breast-fed babies, who also generally own milder reactions.
Exclusive breast-feeding may also protect babies from developing an allergy to cow’s milk protein after they are weaned.
Cow’s milk protein allergy is more likely in children who own other allergic (or atopic) conditions such as asthma, eczema or hay fever, or if shut family members own those conditions.
Symptoms of cows’ milk allergy
Cows’ milk allergy can cause a wide range of symptoms, including:
- hay fever-like symptoms – such as a runny or blocked nose
- skin reactions – such as a red itchy rash or swelling of the lips, face and around the eyes
- digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation
- eczema that does not improve with treatment
Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing.
A severe allergic reaction, or anaphylaxis, is a medical emergency – call 999 or go immediately to your local hospital A&E department.
Could it be lactose intolerance?
Lactose intolerance is another type of reaction to milk, when the body cannot digest lactose, a natural sugar found in milk.
However, this is not an allergy.
Lactose intolerance can be temporary – for example, it can come on for a few days or weeks after a tummy bug.
Symptoms of lactose intolerance include:
- stomach rumbling and pains
Treatment for lactose intolerance
Treatment depends on the extent of your child’s intolerance. Some children with lactose intolerance may be capable to own little amounts of dairy products without having symptoms.
Your kid may be referred to a dietitian for specialist advice.
Read more about treatment for lactose intolerance in children.
Allergic reactions to milk
There are two diverse processes which cause allergic reactions in the body; cow’s milk can trigger either of these in some people. Some people develop symptoms of both types of reaction.
Immunoglobulin E-mediated reactions (IgE-mediated allergy)
These are generally quick reactions which can cause skin rashes and needing to be ill (vomiting).
They happen within two hours of the milk being consumed. They are triggered by the body releasing a chemical called histamine, so antihistamine medicine can be used to treat the symptoms. It is extremely rare that cow’s milk causes a life-threatening anaphylactic reaction.
This type of allergy can be diagnosed with a skin prick test or a blood test. If this type of allergy is suspected, the kid would generally be referred to a children’s doctor (paediatrician) who would arrange for the test to be done in hospital.
Most children with this helpful of allergy grow out of it by the time they are 5 years ancient.
If the reaction has been severe, it may be safest to carry out a challenge test in hospital.
A referral to a paediatrician should be made for either type of reaction if:
- There own been any severe reactions.
- The kid is not growing well.
- Multiple food allergy is suspected.
Non-immunoglobulin E-mediated reactions (non-IgE-mediated allergy)
These are slow reactions which can happen hours, or more generally days, after consuming milk.
There can be a skin reaction such as eczema, tummy (abdominal) symptoms such as pain, reflux or colic or breathing (respiratory) symptoms.
The best way to discover out if the kid has this helpful of allergy is to exclude cow’s milk from their diet. Milk needs to be excluded for at least two weeks, as the symptoms caused by slow reactions also take fairly a endless time to settle.
If the symptoms settle when milk is removed from the diet, a challenge test can be done in which the kid has a little quantity of milk. If the milk causes the same reaction as before, the diagnosis can be confirmed.
It may take several days for the reaction to show. A challenge test can be repeated every few months, as the kid is likely to grow out of this allergy with time.
For babies who are bottle-fed, there is special formula milk available on prescription. This has the proteins broken below so that they do not cause the allergic reaction.
Mothers who are breastfeeding need to exclude milk and milk-containing foods from their diet. They should be prescribed a supplement of calcium and vitamin D, so that they don’t become deficient in these nutrients.
Older babies and children who are on a cow’s milk-free diet for confirmed allergy should see a specialist children’s (paediatric) dietician who can make certain the diet is balanced and contains enough calcium.
It is significant to read the labels on food that you purchase.
Some milk products which are used as ingredients may own names such as casein, whey or curd.
More familiar dairy products such as butter, yoghurt and cheese are also found in numerous packaged foods.
Most children with this helpful of allergy grow out of it by the time they are 3 years old.
Mixed IgE- and non-IgE-mediated allergy
Sometimes there can be a mixture of the two types of allergic reaction. This causes a combination of the two types of allergic responses.
Cows’ milk allergy in babies
Cows’ milk allergy (CMA), also called cows’ milk protein allergy, is one of the most common childhood food allergies.
It is estimated to affect around 7% of babies under 1, though most children grow out of it by the age of 5.
CMA typically develops when cows’ milk is first introduced into your baby’s diet either in formula or when your baby starts eating solids.
More rarely, it can affect babies who are exclusively breastfed because of cows’ milk from the mother’s diet passing to the baby through breast milk.
There are 2 main types of CMA:
- immediate CMA – where symptoms typically start within minutes of having cows’ milk
- delayed CMA – where symptoms typically start several hours, or even days, after having cows’ milk
Treatment for CMA
If your baby is diagnosed with CMA, you’ll be offered advice by your GP or an allergy specialist on how to manage their allergy.
You may also be referred to a dietitian.
Treatment involves removing every cows’ milk from your child’s diet for a period of time.
If your baby is formula-fed, your GP can prescribe special baby formula.
Do not give your kid any other type of milk without first getting medical advice.
If your baby is exclusively breastfed, the mom will be advised to avoid every cows’ milk products.
Your kid should be assessed every 6 to 12 months to see if they own grown out of their allergy.
Read more about cows’ milk allergy.