Cow milk Allergy in Infant
Cow’s milk allergy is said to occur in 2 – 8% of infants. About 5 -15% of infants have a reaction to the cow’s milk protein, but not all of these are allergic reactions. For example, lactose intolerance is not an allergy as such, but children do have a reaction to cow’s milk. Read more about lactose intolerance.
Allergic reactions to cow’s milk may be:
- immediate – within minutes up to 1 hour after having cow’s milk. Symptoms include hives, eczema, facial swelling, wheeze, vomiting, diarrhea. Severe reactions include anaphylaxis.
These are IgE mediated reactions
- delayed – these can occur several hours or even days after having the milk. Symptoms include eczema, vomiting, diarrhea or asthma. Babies may even fail to thrive. These are non IgE mediated reactions.
Cow’s milk protein intolerance is an example of this – sometimes you will see blood in the stool.
Cow’s Milk Allergy diagnosed
The first thing is a good story (history) of a reaction after having cow’s milk.If your infant has had an immediate reaction, then skin prick tests, or blood tests (such as CAP, EAST, RAST) will usually be helpful. These tests detect IgE mediated allergies.In other cases, milk and dairy products may need to be eliminated from the diet in a trial of treatment. If the symptoms resolve and then return when milk is reintroduced into the diet, this is diagnostic for allergy – called Elimination/Reintroduction. If your child has had a severe reaction to milk products, then reintroduction should be done under medical supervision.Some centers offer patch testing, which may be useful in detecting non IgE mediated allergies. Treatment
Cow’s milk will need to be excluded from your baby’s diet. This can be difficult and you may need the help of a dietician.Some breast-fed babies will get symptoms if their mother has cow’s milk (dairy) products in her diet. In these cases, the mother will need to exclude dairy products from her diet.
Foods to be avoided in cow’s milk allergy include:
- any food with cow’s milk or goat’s milk
- milk powder
- cream fraiche, sour cream, cottage cream
- lactalbumin, lactulose, lactoglobulin
- any foods containing any of the above list
Alternatives to cow’s milk include:
- soy protein formula – about half children who are allergic to cow’s milk will also be allergic to soy. Soy formula is not recommended for infants under 6 months but can be tried first as an alternative milk in infants over 6 months of age
- extensively hydrolysed formula (EHF) – this is milk that has been treated to break down most of the enzymes that cause allergic symptoms. These are the first choice alternative for infants under 6 months with cow’s milk allergy. Examples of EHF include PeptiJunior and Alfare. Partially hydrolysed formula (PHF) are not suitable for cow’s milk allergic infants
- amino acid based formula – AAF – this is milk that is completely broken down eliminating the protein that causes allergy. It will be necessary in about 10% of cow’s milk allergic children. Examples of an amino acid based formula include Neocate and Elecare.
AAF should be used in children who do not tolerate EHF (after a 2-4 week trial) or as a first choice in infants with an anaphylactic reaction
JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210
PHONE : (021) 70081995 – 5703646
editor in chief : Widodo Judarwanto,pediatrician
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
Copyright © 2010, Children Allergy Center Information Education Network. All rights reserved