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 - read more. These are IgE mediated reactions - read more 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 so are caused by other immune substances but not IgE.
Examples include: Cow's milk protein intolerance - sometimes you will see blood in the stool. Food Protein Induced Enterocolitis Syndrome (FPIES) - this is the most severe form of non-IgE mediated allergy and causes vomiting 1-3 hours after ingesting milk (or whatever other protein may be involved) and diarrhea about 5-8 hours after ingestion. This can lead to severe dehydration and shock. Babies look pale and lethargic This page answers the following questions: Ads How is 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. Back to list Advertisement What is the treatment of cow's milk allergy? 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.
As cow's milk is in all dairy products, cow's milk allergy is sometimes called dairy allergy. 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 cheese butter ghee milk powder cream fraiche, sour cream, cottage cream whey casein margarine custard lactalbumin, lactulose, lactoglobulin any foods containing any of the above list Back to list What milk alternative should I feed my infant with cow's milk allergy? If you can continue breast feeding, that will be best for your baby.
If not, 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, but do not be surprised if your infant shows an allergic reaction 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 Back to list Advertisement Should I give my baby goat's milk for cow's milk allergy? No. Goat's milk and cow's milk share similar proteins so children who are allergic to one will be allergic to the other.
Goat's milk, sheep's milk, and rice milk are not suitable alternatives in cow's milk allergic children. Sometimes a baby will seem to prefer a goat's milk formula to a cow's milk formula. This is not due to a milk allergy. It's merely a preference. Back to list Can I give my child yoghurt, cheese or cookies? Some cow's milk allergic children will tolerate yoghurt or cheese and have no problem at all with cookies with milk as an ingredient.
This is because heating changes the shape of the protein and this can make it less likely to cause an allergic reaction. Once your child has been symptom free for at least six months, you could try a small piece of cookie (that has milk as an ingredient) - if your child tolerates it, then you can give cookies freely. You could then try yoghurt or cheese as the same may apply. Some children will show a reaction to cookies, yoghurt and cheese and you will just have to keep these out of the diet for a bit longer - you could try again in about 6 months.
Remember leave about 2 weeks between trying a new food. Back to list Advertisement Should I stop breast-feeding my cow's milk allergic baby? This is not necessary in most cases so keep breast feeding your baby as breast milk is best. Cow's milk allergy is less likely in breast fed infants. If your baby has symptoms of cow's milk protein allergy, then you should exclude dairy products and eggs from your diet - you need to continue this for at least 2 weeks, but probably for 4 weeks, to see if there is an improvement.
If there is improvement, one food per week can be introduced into your diet until you know what food is causing your baby's problems and then you can just avoid that food. If you need to continue to eliminate milk from your diet, you may need a calcium supplement. If and when you do wean your baby, you should use an extensively hydrolysed formula (or soy if your baby is over 6 months of age but as mentioned above about 50% of babies allergic to milk will be allergic to soy).
Back to list Will my child grow out of her allergy? Most children grow out of their cow's milk allergy by age 3 years. Once your child is over 12 months old and has been without dairy products in the diet for at least 6 months, you could try introducing some dairy products into the diet - you might want to start with yoghurt or cheese as these are sometimes tolerated better than actual milk. If your child had a severe reaction to the milk in the first place, like anaphylaxis, then you should have the milk challenge under medical supervision - do not try re-introducing milk at home.
Some children grow out of the dairy allergy but develop other allergic diseases, like asthma as they grow older. Back to list Does dairy allergy cause mucus? Symptoms that relate to the respiratory system, such as runny nose and mucus, usually are a result of what we breath not what we eat. Any symptoms of mucus after ingesting milk are not dangerous and in infants are more likely to be the result of a respiratory tract infection rather than an allergy.
Back to list Is eczema caused by milk allergy? In most cases of eczema, there will not be any allergy. However, in some infants, particularly young babies with severe eczema, allergy may be a factor. In these cases, skin prick tests may be positive and even if they are not, it may be worthwhile trying an elimination diet (no dairy, including cow's milk) for 4 weeks to see if there is improvement. If no improvement occurs, cow's milk is unlikely to be contributing to the eczema.
This type of elimination diet is best supervised by your doctor or a dietician. Back to list Should I delay introduction of milk and dairy to prevent eczema or asthma? No, there is no evidence that delaying the introduction of milk or other dairy products will make any difference to whether your child develops eczema or asthma or allergy. Unless your child has shown a clear allergic reaction to milk and dairy, there is no advantage in delaying introduction of it, so give it at the usual time.
This is even when there is a history of allergy, eczema or asthma in your family. There is also no evidence that giving a hydrolysed formula to your baby when there is a family history of allergy will prevent your baby getting allergy, therefore we do not advise this. Back to list What is lactose intolerance? Lactose intolerance occurs because the body lacks an enzyme, lactase, that is necessary to digest the milk sugar, lactose.
People with lactose intolerance will get diarrhea, vomiting and tummy pains - these symptoms are similar to cow's milk allergy, but do not involve the skin. Although the symptoms are a nuisance, lactose intolerance is not dangerous. If you have lactose intolerance, you can usually manage to eat small amounts of cow's milk. Other dairy products, such as yoghurt and cheese, are usually well tolerated because they have easier to digest milk sugars.
The diagnosis is made on a stool test which shows sugars (reducing substances) in the stool or a breath hydrogen test. Treatment is reducing or avoiding products containing lactose (milk sugar) - so reducing or avoiding dairy products. Infants require a lactose-free formula. Back to list References American Academy of Allergy, Asthma and Immunology. The Allergy Report Australasian Society of Clinical Immunology and Allergy Tromp II; Kiefte-de Jong JC; Lebon A; Renders CM; Jaddoe VW; Hofman A; de Jongste JC; Moll HA.
The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the Generation R study.Arch Pediatr Adolesc Med. 2011; 165(10):933-8 (ISSN: 1538-3628) Vanderplas et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child. 2007; 92:902-908 Rance F. Food allergy in children suffering from atopic eczema. Pediatr Allergy Immunol 2008;19:279-284 Ads To go to the top of the milk allergy page, click here To go to the food allergy page, click here To go to the main allergy page, click here To return to the Home page, click here Last reviewed 18 March 2016See Also: Cow Milk Babies
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Overview Milk allergy, one of the most common food allergies in children, is an abnormal response by the body's immune system to milk and products containing milk. Cow's milk is the usual cause, but milk from sheep, goats, buffalo and other mammals also can cause a reaction. An allergic reaction usually occurs minutes to hours after consuming milk. Signs and symptoms of milk allergy range from mild to severe and can include wheezing, vomiting, hives and digestive problems.
Sometimes, milk allergy can cause anaphylaxis — a severe, life-threatening reaction. Avoidance is the primary treatment for milk allergy. Fortunately, most children outgrow a milk allergy. Those who don't outgrow it may need to continue to avoid milk products. Symptoms Milk allergy symptoms, which differ from person to person, occur a few minutes to a few hours after drinking milk or eating milk products.
Immediately after consuming milk, signs and symptoms of a milk allergy might include: Hives Wheezing Vomiting Signs and symptoms that may take more time to develop include: Loose stools, which may contain blood Diarrhea Abdominal cramps Coughing or wheezing Runny nose Watery eyes Itchy skin rash, often around the mouth Colic, in babies Milk allergy or milk intolerance? A true milk allergy differs from milk protein intolerance or lactose intolerance.
Unlike a milk allergy, intolerance doesn't involve the immune system. Milk intolerance causes different symptoms and requires different treatment from a true milk allergy. Common signs and symptoms of milk protein intolerance or lactose intolerance include digestive problems, such as bloating, gas or diarrhea, after consuming milk or products containing milk. Anaphylaxis Milk allergy can cause anaphylaxis, a life-threatening reaction that can narrow the airways and block breathing.
Milk is the third most common food, after peanuts and tree nuts, to cause anaphylaxis. If you or your child has a reaction to milk, tell your doctor, no matter how mild the reaction. Tests can help confirm a milk allergy, so you can avoid future and potentially worse reactions. Anaphylaxis is a medical emergency and requires treatment with an epinephrine (adrenaline) shot and a trip to the emergency room.
Signs and symptoms start soon after consuming milk and can include: Constriction of airways, including a swollen throat that makes it difficult to breathe Facial flushing Itching Shock, with a marked drop in blood pressure When to see doctor See your doctor or an allergist if you or your child experiences milk allergy symptoms shortly after consuming milk. If possible, see your doctor during the allergic reaction to help the doctor make a diagnosis.
Seek emergency treatment if you or your child develops signs or symptoms of anaphylaxis. Causes All true food allergies are caused by an immune system malfunction. Your immune system identifies certain milk proteins as harmful, triggering the production of immunoglobulin E (IgE) antibodies to neutralize the protein (allergen). The next time you come in contact with these proteins, IgE antibodies recognize them and signal your immune system to release histamine and other chemicals, causing a range of allergic signs and symptoms.
There are two main proteins in cow's milk that can cause an allergic reaction: Casein, found in the solid part (curd) of milk that curdles Whey, found in the liquid part of milk that remains after milk curdles You or your child may be allergic to only one milk protein or 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 will react to sheep's, goat's and buffalo's milk.
Less commonly, people allergic to cow's milk are also allergic to soy milk. Food protein-induced enterocolitis syndrome (FPIES) A food allergen can also cause what's sometimes called a delayed food allergy. Although any food can be a trigger, milk is one of the most common. The reaction, commonly vomiting and diarrhea, usually occurs within hours after eating the trigger rather than minutes. Unlike some food allergies, FPIES usually resolves over time.
As with typical milk allergies, preventing an FPIES reaction involves avoiding milk and milk products. Risk factors Certain factors may increase the risk of developing a milk allergy: Other allergies. Many children allergic to milk also have other allergies. Milk allergy is often the first to develop. Atopic dermatitis. Children who have atopic dermatitis — a common, chronic inflammation of the skin — are much more likely to develop a food allergy.
Family history. A person's risk of a food allergy increases if one or both parents have a food allergy or another type of allergy — such as hay fever, asthma, hives or eczema. Age. Milk allergy is more common in children. As they age, their digestive system matures, and their bodies are less likely to react to milk. Complications Children who are allergic to milk are more likely to develop certain other health problems, including: Allergies to other foods — such as eggs, soy, peanuts or even beef Hay fever — a common reaction to pet dander, dust mites, grass pollen and other substances Prevention There's no sure way to prevent a food allergy, but you can prevent reactions by avoiding the food that causes them.
If you know you or your child is allergic to milk, avoid milk and milk products. Read food labels carefully. Look for casein, a milk derivative, which can be found in some unexpected places, such as in some canned tuna or nondairy products. Question ingredients when ordering in restaurants. Sources of milk products Obvious sources of allergy-causing milk proteins are found in dairy products, including: Whole milk, low-fat milk, skim milk, buttermilk Butter Yogurt Ice cream, gelato Cheese and anything that contains cheese Half-and-half Milk can be harder to identify when it's used as an ingredient in processed foods, including baked goods, processed meats and breakfast cereals.
Hidden sources of milk include: Whey Casein Ingredients spelled with the prefix "lact" — such as lactose and lactate Candies, such as chocolate, nougat and caramel Protein powders Artificial butter flavor Artificial cheese flavor Hydrosolate Even if a food is labeled "milk-free" or "nondairy," it may contain allergy-causing milk proteins — so you have to read the label carefully. When in doubt, contact the manufacturer to be sure a product doesn't contain milk ingredients.
When eating out, ask how foods have been prepared. Does your steak have melted butter on it? Was your seafood dipped in milk before cooking? If you're at risk of a serious allergic reaction, talk with your doctor about carrying and using emergency epinephrine (adrenaline). If you have already had a severe reaction, wear a medical alert bracelet or necklace that lets others know you have a food allergy.
Milk alternatives for infants Some research suggests that breast-feeding during the first four to six months of a baby's life instead of giving a standard cow's milk formula can help prevent milk allergy. In children who are allergic to milk, breast-feeding and use of hypoallergenic formula can prevent allergic reactions. Breast-feeding is the best source of nutrition for your child. Breast-feeding for at least the first four to six months of life if possible is recommended, especially if your infant is at high risk of developing a milk allergy.
Hypoallergenic formulas are produced by using enzymes to break down (hydrolyze) milk proteins, such as casein or whey. Further processing can include heat and filtering. Depending on the level of processing, products are classified as either partially or extensively hydrolyzed. Or they may also be called elemental formulas. Some hypoallergenic formulas aren't milk based, but instead contain amino acids.
Besides extensively hydrolyzed products, amino-acid-based formulas are the least likely to cause an allergic reaction. Soy-based formulas are based on soy protein instead of milk. Soy formulas are fortified to be nutritionally complete — but, unfortunately, some children with a milk allergy also develop an allergy to soy. If you're breast-feeding and your child has a milk allergy, cow's milk proteins passed through your breast milk may cause an allergic reaction.
Then you may need to exclude all products that contain milk from your diet. Talk to your doctor if you know — or suspect — your child has a milk allergy and develops allergy signs and symptoms after breast-feeding. If you or your child is on a milk-free diet, your doctor or dietitian can help you plan nutritionally balanced meals. You or your child may need to take supplements to replace calcium and nutrients found in milk, such as vitamin D and riboflavin.
By Mayo Clinic Staff Aug. 07, 2014