Cow’s Milk Protein Allergy in Babies

Cow’s milk contains 2 types of protein – whey and casein. When a child has a Cow’s Milk Allergy (CMA) it is one or both of these proteins that is the allergen. Casein is found in the solid part (curd) of milk that curdles. Whey is found in the liquid part of milk that remains after milk curdles. Your child may be allergic to only one milk protein or to both. These proteins may be hard to avoid because they’re also in some processed foods. And most people who react to cow’s milk may also react to sheep’s, goat’s and buffalo’s milk. More commonly, people allergic to cow’s milk may also allergic to soya milk.

Cow’s Milk Protein Allergy (CMPA) can be a very complex condition and when we see babies and children who we suspect have a CMPA in our clinic, we always refer them to a Paediatric Dietitian. Cow’s Milk Allergy (CMA) is the most common food allergy seen in infants and children. Between 2 and 7.5% of children are estimated to have CMA. However, the actual numbers could be much higher as there’s a high rate of failure to diagnose the Delayed Onset type of CMA. This is backed up by a 2009 study in the UK where it was demonstrated that, of 1000 children with a diagnosis of CMA, there was considerable under diagnosis, delayed diagnosis and incorrect diagnosis. CMA can present with a spectrum of acute or delayed symptoms that can be mild, moderate or severe in nature – easy to see how it can be misdiagnosed or missed isn’t it!

There are 2 different types of Cows Milk Allergy to look at.

 1. IgE mediated CMA – Acute Onset; This type typically occurs within a few minutes of taking cow’s milk protein and symptoms can range from mild urticaria (rash) to serious anaphylaxis. This is certainly the more serious of the 2 types and is likely to last longer. It’s easier to diagnose as the symptoms relate to the intake of dairy and are obvious. It presents as a very typical allergy that most people will recognise and seek medical attention for.

 2. Non IgE-mediated CMA- Delayed Onset; This type of CMA occurs several hours or days after taking cow’s milk protein and tends to affect the gastro-intestinal tract, the skin and the respiratory system. This is the type of CMA we see most frequently at the clinic. Because of the delayed signs and symptoms, it can be difficult to pinpoint the food causing the allergy in older children and therefore difficult to get a diagnosis. With babies under 6 months old it’s slightly more straight forward as they only drink milk.

There are several circumstances that can help point to a diagnosis of Cows Milk Allergy. Many medical practitioners rely on these associated circumstances to make their diagnosis and therefore it’s important to tell your Doctor if your baby has any of the following.

1. A family history of allergy, most significant in parents and siblings.

2. Symptoms that are persistent and affect different systems – gastrointestinal, skin, respiratory.

3. Babies who have moderate to severe atopic eczema or dermatitis.

4. Babies who have gastro-oesophageal reflux disease (GORD) or any other gastrointestinal symptoms such as “colic”, loose stools, constipation.

The Happy Baby Academy is our online resource for Downloads about issues we see every day at our clinic. We also have Free Downloads for parents about feeding, changing formula, sleep etc.