This post is also available in: Svenska
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 eating dairy-free formula or if the nursing mother eats cow’s milk protein-free foods. Children can even have milk protein allergy when they’re older. Do not confuse milk protein allergy with lactose intolerance. Both lactose and milk protein are found in milk, but symptoms and 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 talking about. This is closely related to the goat’s milk protein, which is why many cow’s milk protein allergic children are also allergic to goat’s milk protein. However the milk proteins are different from human breast milk protein, so this should 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
You can thus 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 in, I recommended you contact a dietitian if you as a nursing mother. And do not forget the vitamin C tablets! 1000 mg/day should be consumed during the dairy-free nursing time. 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 the 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. Thankfully in Sweden it is subsidized 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 again this affects the county council fund and not the family’s 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 meet a dietitian for advice if you need to bring up 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 from 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 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 your child sees a pediatrician, preferably via medical center. If the child does not poop large amounts of blood, you can skip the children’s emergency room and avoid all the stomach viruses that are there.
Milk protein allergy can manifest on the skin as eczema. Eczema in babies often sits on the cheeks and are red rashes that merge into each other (not to be confused with newborn “hormone spots”, which looks like mini-pimples, is perfectly healthy, and disappears by itself). Some children get hives from milk which means 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 when 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!