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Milk protein allergy, also known as cow’s milk allergy, milk allergy or cow’s milk protein allergy (CMPA) is a tricky condition often suspected in screaming infants. These children may feel better if the nursing mother eats dairy-free foods or if these children are given dairy-free formula. Even older children may have milk protein allergy. Do not confuse milk protein allergy with lactose intolerance. Both lactose and milk protein are found in milk, but symptoms, disease and treatment are completely different.
Milk protein allergy = cow’s milk protein allergy (CMPA)
We often say milk protein allergy, but it’s the cow’s milk protein that we’re referring to. Cow’s milk protein is quite closely related to the goat’s milk protein. This is why many cow’s milk protein allergic children, are also allergic to goat’s milk protein. However, it is sufficiently different from human milk protein for breast milk to be tolerated well.
Cow’s milk protein that mom eats, transfers to breast milk
The basic rule you learn in medical school is that all protein is broken down into amino acids in the gut and is absorbed in this way in the body. But rules have exceptions. Obviously, larger portions of protein can both be absorbed into the mother’s bowel and passed on out into the milk and cause allergic symptoms in the baby.
If mom doesn’t eat cow’s milk protein, the milk will be cow’s milk protein-free
Therefore, you can breastfeed a cow’s milk protein allergic child if you eat a strictly cow’s milk protein-free diet. The hard part is that milk is hidden as an additive in very many products. If you are not used to reading tables of contents and don’t know exactly what words milk can be hidden under, I recommend you contact a dietician if you plan to nurse your cow’s milk protein allergic baby on a milk-free diet. And do not forget the vitamin C tablets! 1000 mg/day should be consumed during the dairy-free nursing period. Preferably with vitamin D.
Some children react to the mother initiating small amounts of cow’s milk protein, others can handle larger amounts without symptoms. And some can handle their mom’s milk protein intake, but react to milk formulas.
Formula is based on cow’s milk protein
Common infant formula (Babysemp, NAN) is based on cow’s milk protein. There are special formulas that you get on prescription with chemically broken (hydrolyzed) cow’s milk protein that works for most cow’s milk protein allergic children. Althera, Pepticate and Nutramigen and Profylac are four different brands of hydrolyzed formula. They are very expensive. But this does not affect the families in Sweden because they are subsidised if prescribed by doctors.
Some children who are extremely sensitive to cow’s milk protein, or have very severe symptoms, may need formulas based on free amino acids, which has nothing to do with cow’s milk protein. There are two such products in Sweden: Neocate and Nutramigen AA. They are even more expensive than the aforementioned preparations. But thankfully this also affects the county council fund and not the family fund in Sweden.
Dairy-free food for older children
Many children who have been cow’s milk protein allergic as babies begin to tolerate milk protein when they get a little older. Often it is good to let them try plain butter and cheese when they start eating food. If they can tolerate it, then the milk protein allergy has grown away. If they get symptoms, then it hasn’t grown away yet.
It is often good to talk to a dietician for advice if you need to raise your baby on a cow’s milk protein-free diet after the lactation/formula period.
Symptoms of cow’s milk protein allergy
Milk protein allergy usually causes symptoms in the gastrointestinal tract, the skin and mood. From the gastrointestinal tract, the symptoms can be basically all imaginable: a lot of vomiting, diarrhea or constipation. Blood in the poo in infants does not always occur in milk protein allergy, but if an infant poops blood, the doctor should always suspect milk protein allergy. And as a parent, you should make sure to see a pediatrician, preferably via medical center. If your child does not poop large amounts of blood, you can skip the children’s emergency room and all stomach sickness that are there.
Milk protein allergy can manifest on the skin as eczema. Eczema in babies often sit on their cheeks and is a redrash that merge into each other. (Not to be confused with newborn “hormone spots”, which looks like mini-pimples. These are perfectly healthy and disappears by itself). Some children get hives from milk, they usually have an IgE-mediated allergy.
Tempers are often due to milk protein allergy. Babies can scream and be difficult to console. Maybe they have a stomach ache? Maybe they feel sick?
Are there any tests for milk protein allergy?
There are skin prick tests, but they only test so-called IgE-mediated allergy. For an allergy associated to the skin, the skin prick test is useful. But for gastrointestinal tract and mood symptoms, the skin prick test or blood test is not very useful.
The most effective test is a controlled “elimination exposition”. In conjunction with a medical doctor or pediatrician, the mother tries a strict dairy-free diet if she is breastfeeding, or the baby drinks a cow’s milk-free formula, for two weeks. Then you keep a symptom diary one week before and during the investigation. Afterwards you reintroduce milk again. And again, keep a symptom diary.
If the baby feels much better in the stomach, skin or mood during the dairy-free test period and then feels worse when they receive the regular formula or the nursing mother starts eating milk again, then a doctor can diagnose it as cow’s milk protein allergy.
Milk protein allergy often goes away as the child gets older
Milk protein allergy is most common during the first year of life affecting 2-3% of all children. At one year of age, half have lost their allergy. At the age of three, three out of four lose their allergy, and at the age of 6, nine out of ten children can tolerate milk. Interesting!