15th January 2018
Cow's Milk Protein Allergy
This week’s blog is predominantly about Cow’s Milk protein allergy but also touching briefly on lactose intolerance as it is something that as a health visitor I come across very frequently in my clinics. Hopefully by the end of the blog, you will have a clear understanding of the primary differences between the two conditions and if you feel that you recognise any of the symptoms in your child, you have a clear pathway to follow with regards to seeking help.
What is Cow’s Milk Protein Allergy? (CMPA)
CMPA is an adverse reaction to cows’ milk that resulting from an immunologic hypersensitivity to one or more milk proteins (Hill DJ et al 1986).
Symptoms of CMPA
Typical symptoms of CMPA are wide ranging but usually include 2 of the 3 organ systems below:
The skin – itching, redness, eczema, hives or swelling.
- Gastro intestinal - excessive crying, vomiting, food refusal or aversion, reflux, constipation, red bottom, diarrhoea, abdominal pain or discomfort, blood and/or mucous in stools in an otherwise well infant.
- Respiratory tract - runny nose/sniffles, wheezing, coughing, sneezing, itchy blocked nose, conjunctivitis.
- Whilst some babies may only display one or two symptoms, it is not unusual for some children to have several symptoms and in rare cases there can be an extreme anaphylactic reaction to cows’ milk.
While some symptoms of CMPA are quite obvious, others can be hard to distinguish. For example, some of the symptoms that it may cause such as eczema, reflux, colic, diarrhoea and faltering growth are all common in infancy and have many different causes so this can delay diagnosis. If this is the case, it would be sensible to focus on an allergy history as a significant number of children with CMPA will have a family history of allergy or a personal history of other allergic diseases. Sometimes diagnosis is quite straight forward in that the child may have increasing symptoms which correlate to a move from breast milk to a cow’s milk formula.
Another barrier to diagnosis is that many children with CMPA will continue to thrive and their growth will not falter and this sometimes leads to a false sense that any symptoms, particularly the gastrointestinal symptoms must be mild.
The Good News!The prognosis of CMPA is good with a 90% remission rate at 3 years of age. For a few children, it may last until they are around 6-8 years old.
Management of CMPA
Managing CMPA involves removing all cows’ milk from your baby’s diet. If you are breast feeding, your baby may be reacting to the milk proteins passing from the mother’s diet into her breast milk so if your baby is diagnosed with CMPA then it would be sensible to change your diet accordingly. This is quite rare though and should only be done under supervision.
It is also worth noting that it has been known for babies to be prescribed soya milk if CMPA has been suggested. Firstly, Soya milk is not recommended in children under 6 months as it has phytoestrogen content (phytoestrogens are plant based compounds with oestrogen like properties). Also, many children who are allergic to cows ’milk protein will also be allergic to soya too.
Lactose intolerance produces symptoms similar to those exhibited with CMPA. The main difference between the two conditions is that lactose intolerance does not involve the immune system. With lactose intolerance, unpleasant symptoms such as diarrhoea, bloating or an upset tummy may occur because the digestive system does not produce sufficient quantities of lactase which is the enzyme needed to break down the lactose, so instead it is fermented by bacteria in the large intestine. The undigested lactose will pass through the large intestine where it has an osmotic effect of drawing in water leading to diarrhoea which is commonly seen.
There are 3 types of lactose intolerance but the most common one is Secondary lactose intolerance. This is seen fairly often after there has been damage to the gut lining, for example after a bout of gastroenteritis.
Treatment for Lactose Intolerance
Once lactose intolerance has been diagnosed, babies maybe recommended a lactose-free formula milk. These are nutritionally complete formula milks which can be used from birth for babies who have a congenital lactose deficiency or for a period of 6-8 weeks for children who have a secondary lactose intolerance.
If you have older children and you feel that they are getting symptoms after ingesting milk or dairy, I would strongly suggest that you visit your GP or dietician before removing any food/food group from their diet.
Allergies and the Nursery.The nursery will make every provision to ensure the health and well being of your child but in order for that to happen they require either a doctor or dieticians letter confirming the diagnosis. As soon as this is done, an individual, unique medical care plan can be collated in conjunction with the parents to ensure that your child’s requirements are met as it will provide more information about your child’s specific condition, requirements and action required in the event of an emergency.