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Slideshow: Caring for an infant with cows' milk allergy

What is cows' milk allergy?

Cows' milk allergy – also known as cows' milk protein allergy - occurs when your baby's immune system mistakenly thinks proteins in milk and milk protein-containing products are a threat to the body, and responds to this. The proteins may be in formula, or in breastmilk from the foods mum has consumed.

Signs to watch for

Cows' milk allergy is the most common food allergy in children and affects around 7% of babies and young children in the UK. Babies and children are at higher risk of developing cows' milk allergy if allergy runs in the family. Many children who react to cows' milk protein will also react to the proteins in sheep and goats' milk too. Typical symptoms may include:

  • Rash or hives around the mouth
  • Itchy rash or lumps on the body
  • Facial swelling
  • Wheezing
  • Vomiting
  • Diarrhoea.

Spotting delayed reactions

It's also possible for your baby to have a delayed allergic reaction to milk or milk products. In these cases, symptoms emerge more slowly and may include:

  • Posseting (vomiting) milk
  • Colic 
  • Constipation
  • Diarrhoea
  • Lack of appetite
  • Eczema.


Recognising serious reactions

Rarely, cows' milk allergy can trigger a serious life-threatening reaction known as anaphylaxis. Symptoms of anaphylaxis develop soon after consumption of milk or milk protein-containing products. Seek help immediately if your child develops any of these signs:

  • Hives or skin swelling
  • Wheezing or difficulty breathing
  • Swelling of lips, mouth, throat or tongue
  • Floppy body and limbs
  • Unresponsiveness.

Anaphylaxis can develop quickly and be life threatening, so call 999 immediately.

Diagnosing cows' milk allergy

There are guidelines for GPs to help diagnose children with a suspected cows' milk allergy. Your child may be referred to a specialist at an allergy clinic where tests may include:

  • Blood tests
  • A skin prick test.

Also, a supervised elimination of cows' milk from the diet may be recommended, and after an appropriate period without cows' milk a re-introduction of cows' milk into the diet under controlled hospital conditions may be recommended. A delayed allergic reaction can be harder to diagnose, so a special diet may be recommended and supervised by a dietitian. Alternative tests such as hair analysis, vega tests and applied kinesiology are not able to accurately diagnose any allergy so are not recommended by the NHS.

Foods to avoid

If your baby is allergic to cows' milk proteins there's a chance she will also be allergic to milk from goats and sheep too. Your doctor or a dietitian can help you make dietary changes. Foods to cut out of the diet include:

  • Milk, yoghurt, fromage frais, cream, butter, margarine, ghee and cheese
  • Ice cream, milk drinks, milk powder, quark and condensed milk.

Milk is "hidden" in lots of food products, so check labels for ingredients like:

  • Milk sugar, lactose, milk solids, milk protein, modified milk
  • Casein and caseinates, whey protein, hydrolysed whey and whey solids
  • Lactose and Lactalbumin
  • Hydrolysed caseinates
  • Skimmed milk powder, non-fat milk solids and butter fat.

Under food labelling law, foods containing milk must highlight the word in bold on the ingredients list.

Lactose intolerance

Some symptoms may appear like cows' milk allergy but are actually signs of lactose intolerance, when natural milk sugar can't be broken down. Lactose intolerance is uncommon in babies. Lactose intolerance causes wind, diarrhoea, stomach cramps and bloating.

Colic or allergy?

The symptoms of colic and cows' milk allergy are similar and easily confused. Also bear in mind that cows' milk allergy can trigger colic. If your baby has cows' milk allergy, you may see classic, colic symptoms like intense crying, clenched fists and an arched back, as well as symptoms like:

  • Eczema
  • Diarrhoea
  • Vomiting.

If in doubt, seek medical advice for a correct diagnosis.

Breastfeeding and cows’ milk allergy

If you're a breastfeeding mum, a healthy, varied diet is best for you and your baby. However, you may start noticing reactions in your baby after you've eaten certain foods, such as dairy. Cows' milk proteins pass into your milk, and are linked with discomfort in babies with cows' milk allergy. Signs may include:

  • Crying a lot
  • Discomfort after feeds
  • Sleep problems
  • Tummy upsets, diarrhoea or constipation
  • Cold-like symptoms, wheezing
  • Itchy, red eyes
  • Dry skin or a sore bottom.

Amending mum's diet

If you think your breastfed baby is reacting to milk products that you have eaten, talk to your GP. It may be recommended that you avoid dairy for at least 2-3 weeks to see if the baby's symptoms improve. If dairy is the culprit, you should see an improvement in your baby's symptoms within a week, but it can take as long as several weeks to see a change. You don't always have to give up dairy altogether. It will depend on the severity of the baby's reaction. Discuss your approach with your GP who may recommend getting help from a registered dietitian.

Fixing the formula

Your doctor may suggest using an alternative type of formula if your baby shows signs of allergy to cows' milk protein. This may involve an extensively hydrolysed (eHF) milk formula where milk proteins are broken down into smaller, more digestable parts, which makes them less likely to trigger an allergy. There are also amino-acid based formulas, which don't contain any protein chains, that may be recommended if a child has difficulty with extensively hydrolysed milk formula or has severe symptoms.

Playtime hazards

Be extra vigilant with your baby who has cows' milk allergy during playtime with other children. It's easy for icecreams to melt into paddling pools or sand, so keep an eye open for exposure to milk products this way and always let nursery staff or babysitters know about allergies and how to care for your infant if you are away from them.

Getting help

To help your doctor help you, you may want to consider a symptoms diary:

  • Note when and where reactions happen
  • List types of foods that trigger reactions
  • Note what kind of reactions occur ie: rash, wheezing
  • Note how long symptoms persist
  • Note what seems to relieve reactions.

Managing cows' milk allergy

Right now, the best management of cows' milk allergy in babies is to make sure they avoid cows' milk proteins completely. If you're breastfeeding, consult your GP to decide whether to cut down or eliminate dairy products from your diet. If you are bottle-feeding, cows' milk substitutes include:

  • Extensively hydrolysed formulas
  • Amino acid-based formulas.

Your GP will be able to help you manage your child's cows' milk allergy. More complex cases like multiple allergies, an uncertain diagnosis, severe reactions or stunted growth can be referred to a specialist.

The outlook

Fortunately, most children grow out of cows' milk allergy by the age of 5 years old, but some people still have an allergic reaction when they're adults. Don't try to go it alone and cut essential foods out of your child's diet. Talk to your GP who can refer you to a registered dietitian who can advise on how to make sure your child has a nutritious diet whilst excluding the food group being monitored.

Could your child have a milk allergy?

Reviewed by Dr Rob Hicks on June 15, 2016

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