Cow's milk allergy

Children are commonly affected by cow’s milk allergy. In the range of 0.3% to 3.5% of young children in the UK are affected.1 The good news is that by 12 months of age approximately 50% of babies will have grown out of their cow’s milk allergy – however in some cases cow’s milk allergy may continue longer into childhood, typically resolving between the age of three to five years.1,2

Cow’s milk allergy is caused by the body’s immune system which ‘fights’ a food protein unnecessarily, resulting in an abnormal reaction to the given food. There are two main proteins in cow's milk that can cause an allergic reaction; casein and whey.

Your baby may be allergic to one or both proteins, and it is important to know that they are not only present in cow’s milk, but also found in a variety of pre-prepared foods as well. So if you are starting to wean your baby onto solid foods, always keep this in mind. If your baby is allergic to cow’s milk, it is also common for them to be allergic to other types of milk such as goat and sheep, so these should be avoided as well.

If you are breastfeeding your baby, you may need to avoid products containing cow’s milk as allergenic cow’s milk proteins can be transferred to your baby.3 It is important that you seek the advice of a healthcare professional when doing so to ensure you continue to eat a balanced diet and receive sufficient nutrients to meet the demands of breastfeeding. For more information, click here.

If you have any concerns, please discuss these with your
healthcare professional.

References

  1. Venter C and Arshad SH. Pediatr Clin N Am 2011;58(2)327-349.
  2. Høst A et al. Pediatr Allergy Immunol 2002;13(S15):23-28.
  3. Vandenplas Y et al. Arch Dis Child 2007;92:902-908.

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RXANI140098 Date of preparation: March 2014

Symptoms of cow's milk allergy

If your baby is allergic to cow’s milk, common symptoms can include the following which typically affect the skin, gut and respiratory system - however each baby can react to cow’s milk differently:1

SkinDigestive tractLungs and airways

Itching (pruritus)

Nausea

Difficulty in breathing

Eczema

Vomiting

Runny nose

Mild through to raised and itchy rashes (erythema and urticaria)

Diarrhoea

Wheezing

Swelling of the skin (angioedema)

Colic

Chronic cough

 

Swelling of lips, tongue and palate (angioedema)

 
 

Red and inflamed bottom (perianal redness)

 
 

Reflux

 
 

Stomach pain

 
 

Food refusal

 

The symptoms listed in the above table are not exhaustive and they may develop immediately – through to several hours, or days, after consumption of cow’s milk. The speed of the onset of these reactions can be divided into two categories:2


Immediate – reactions can occur up to two hours after eating


Delayed – reactions can occur within a few hours up to
three days after eating

If you suspect your baby has an allergy to cow’s milk it is essential you speak to your healthcare professional who will be able to diagnose the allergy and support you in managing your baby’s condition.

Your healthcare professional will review your baby’s symptoms and medical history. They may use a blood or skin test to confirm the diagnosis of cow’s milk allergy. A full medical examination may also be conducted to rule out the possibility of any other underlying conditions.

To help prepare for your visit with a healthcare professional, why not take a look at our Parents guide to seeking advice from a healthcare professional.

If you have any concerns, please discuss these with your
healthcare professional.

References

  1. NICE, 2011: http://www.nice.org.uk/nicemedia/live/13348/53214/53214.pdf Accessed 14th August 2013.
  2. Shaw V and Lawson M (Eds). Clinical Paediatric Dietetics 3rd edition. Blackwell Publishing: Oxford 2010 pp260-261.

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Managing cow's milk allergy

Breastfeeding is best for babies and is recommended for as long as possible during infancy, but if your baby is not being breastfed, a hypoallergenic infant formula should be used. Hypoallergenic infant formulas are foods for special medical purposes and should be used only on the advice and under the supervision of a healthcare professional.

Proteins in standard infant formulas are recognised by the immune system, and can trigger allergic reactions in babies with cow’s milk allergy. Hydrolysing or breaking down proteins into small pieces (peptides and amino acids) reduces the likelihood of the immune system recognising the protein, and in turn, the likelihood of an allergic reaction.

Specialist infant formulas can contain whole protein or be partially or extensively hydrolysed, with the difference lying in the size of the protein pieces.1 Partially hydrolysed formulas are not suitable for the dietary management of cow’s milk allergy as the protein pieces are still fairly large and may still trigger an allergic reaction.1

The British Dietetic Association recommends that babies under the age of six months are not fed soya-based infant formulas. In the UK, the Chief Medical Officer also advises against the use of soya-based infant formulas in babies under the age of six months. This is due to the phytoestrogen content, a naturally occurring compound found in plants, and the possibility of children with cow’s milk allergy also being allergic to soya protein.2, 3

If you have any concerns, please discuss these with your
healthcare professional.

References

  1. Høst A et al. Arch Dis Child 1999;81:80-84.
  2. Jones W. Breastfeeding and Medication. Routledge; 2013, pp 55.
  3. CMO, 2004: http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4070176.pdf Accessed 14th August 2013.

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Advice for breastfeeding mums
on going dairy-free

If your baby has cow’s milk allergy, you may need to go ‘dairy-free’ whilst you are breastfeeding. Thankfully, labelling on food products has improved a lot - making it easier to check for specific ingredients.1 However, it is still important you read the food label every time as it’s often surprising how many foods contain milk derived ingredients.1 Equally, by checking you can ensure you do not unnecessarily cut out foods.

The following are examples of pre-prepared foods which may contain milk:1

  • Breakfast cereals
  • Soups
  • Baby foods
  • Processed meats, e.g. sausages, pate, meat pies
  • Pizzas
  • Sauces and gravies
  • Baked goods, e.g. bread, rolls, buns, brioche
  • Pancakes, batters
  • Ready meals
  • Puddings and custards
  • Cakes, biscuits, crackers
  • Chocolate and confectionery
  • Crisps, flavoured nuts and tortillas

Ingredients and foods
which contain milk:1

  • Milk powder / skimmed milk powder
  • Milk drinks / malted milk drinks
  • All types of cheese / cheese powder
  • Butter
  • Margarine / low fat spread unless it states it is dairy free
  • Yoghurt / quark / fromage frais
  • Cream / sour cream
  • Casein / caseinates / sodium caseinates / hydrolysed casein
  • Milk solids
  • Non-fat milks
  • Whey
  • Whey syrup sweetener
  • Milk sugar solids

Good alternatives to cow’s milk include: calcium enriched almond, hazelnut, hemp, oat or coconut milks which can be used on cereal or in hot drinks. A great tip is to visit your supermarket with a list of all the foods you would normally eat and take the opportunity to go through the items and check their ingredients. Most supermarkets now have a ‘Free From’ aisle with suitable alternatives.

You should aim to include protein at lunch and dinner, plus two or three nutrient dense snacks per day. Snacks could include a range of energy and nutrient dense foods such as:

  • Houmous with breadsticks
  • Avocado slices or guacamole in pitta bread
  • Short asparagus spears wrapped in Parma ham or drizzled with olive oil
  • A few squares of dark chocolate
  • Fruit smoothies either homemade (fresh fruit, fruit juice, a little coconut cream) or shop bought (without milk)
  • Pitta pockets with flaked tuna or sliced chicken, salad, tomatoes
  • Soup with croutons or slice of bread (taking care to avoid ‘cream of’ / ‘miso’ soups)
  • A small pot of rice noodles with chilli sauce and vegetables
  • Peanut butter or other nut butters or ‘Free From’ chocolate spread on toast with sliced banana
  • Dried apricots, mango or avocado

Please note that individual foods may vary and you should always check the label before eating. Tortilla wraps or flat breads make quick and healthy lunches, they can be filled with tuna or mackerel fillets, salad and sliced tomatoes. Alternatively, a deep filled sandwich with cold meats and salad, followed with a small slice of ‘Free From’ cake or granola style bar can be a tasty option.

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For a treat, you can enjoy a wide range of ‘Free From’ ice-creams, sorbets and non-dairy yoghurts. Cakes and bakes can be made using dairy-free margarine and to help improve the taste of ‘Free From’ home-made cakes try adding cocoa powder.

As you are excluding cow’s milk from your diet it is important to ensure you are getting enough calcium. This is especially important if you are breastfeeding, so consider talking to your healthcare professional regarding calcium supplementation.2 To help top up your calcium intake to ensure you hit the recommended level for breastfeeding, supplements can be taken, as well as calcium enriched coconut and almond milks for example. There are also non-dairy foods which are good sources of calcium, such as kidney beans, okra, apricots and currants.1

It is worth noting that just because one brand of food contains milk, a different brand may not, so keep checking those labels! Also, less expensive / economy brands can often be milk free whereas the luxury versions tend to be more likely to contain butter and cream.

Note: Before any changes are made to you or your child's diet, you should seek advice from your healthcare professional.

References

  1. Allergy UK, 2012: http://www.allergyuk.org/common-food-intolerances/dairy-intolerance Accessed 14th August 2013.
  2. Shaw V and Lawson M (Eds). Clinical Paediatric Dietetics 3rd edition. Blackwell Publishing: Oxford 2010 pp197.

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RXANI140098 Date of preparation: March 2014