Cow’s milk protein allergy is one of the most common food allergy happened in babies. It is confirmed that 5-15% of baby are suffered from adverse reaction from cow’s milk protein. Babies who are exclusively formula fed are in the high risk of getting cow’s milk protein allergy than breastfed babies. However, breastfed babies may also get the allergen from the mother if the mothers consume the dairy products which contain casein protein can transmit via human milk to the babies.
The statistics also show the cow’s milk protein allergy can be developed during neonatal stage, reach at its peak when the baby are around 1 year old, and mostly will be resolved when the children reach at the age of 3-4 years old. Only minor group may reach up to 18 years old.
I will be sharing some insight about the cow’s milk allergy, the symptoms of milk allergy and ways to prevent it. I hope you will find it useful.
What is cow’s milk protein allergy
Based on World Allergy Organization, the definition of adverse reaction to milk is known as milk hypersensitivity and can be divided into
- Immune mediated hypersensitivity or milk allergy
- Non immune mediated hypersensitivity or milk intolerance
Sometimes, we get confused about the milk allergy and milk intolerance due to their shared symptoms. Milk allergy is due to immune reaction to casein protein in cow’s milk whereas milk intolerance is due to lack of enzyme (lactase) to metabolize lactose existed in milk, in the intestines.
Besides cow’s milk protein allergy, children are also prone to other food allergen such as eggs, soy, peanuts, tree nuts, fish, shellfish and wheat. Almost 90% childhood allergy is due to cow’s milk protein allergy because milk is their main source of food before they reach 6 months old.
Cow’s milk protein allergy symptoms can be divided into two:
- immediate onset of allergy reaction which happened within minutes of ingestion of cow’s milk. Some common symptoms associated with immediate reaction are
- wheezing due to difficult in breathing
- hives ( appear as swollen red bump on the skin and cause itchiness)
- In some cases, it can cause serious problem and is potentially fatal. It is called anaphylaxis ( or anaphylactic shock) in medical terms and it will cause swelling of the throat and mouth, a drop in the blood pressure and difficulties in breathing. Immediate medical attention is needed to ease the situation.
- Late onset of allergy reaction which can develop from few hours to several days of ingestion of cow’s milk. The late onset reaction symptoms includes
- skin rashes e.g eczema
- diarrhea (sometimes come with blood or mucus)
- colic (unexplained crying and fussy for more than 3 hours, at least 3 times a week and can last for 3 weeks time)
- recurrent fever
- poor weight gain
There are solutions how to overcome the cow’s milk protein adverse reaction. I have listed the major two:
Breast milk is the best source of nutrient for babies. For nursing moms, just be aware of the food intake. Avoid the eight main food allergens in your diet as it will transmit through the breast milk to the babies. In a nutshell, fully breastfeed with human milk is the best solution.
If breastfeeding is not possible due to some reason, the best way is to implement elimination diet, avoid cow’s milk intake totally. There are some good alternatives to replace cow’s milk formula and they are clinically proven which can tolerate better than cow’s milk and less likely to cause adverse allergy reaction to babies.
Substitution for cow’s milk
Substitution for cow’s milk may not be necessary for exclusive breastfed babies and children above 2 years old. For babies below 2 years old who are mixed fed or fully formula fed, substitution is essential to replace cow’s milk. There are 3 type of substitutions which I will discuss here in this post.
Hydrolyzed formula is invented to overcome cow’s milk protein allergy after soy protein formula. Soy protein formula was first introduced as an alternative formula to overcome the issues of getting cow’s milk protein allergy reaction but 8-14% for those with symptoms associated with cow’s milk protein allergy still react adversely to soy. However, report on anaphylaxis on baby fed on soy protein formula is extremely rare.
However, none of the hydrolyzed formulas are completely safe. There are still better alternatives and are meeting the standard for hypoallergenicity too.
1. Extensively hydrolyzed milk – the protein structure has been broken down to smaller pieces protein for easy digestion. They are hypoallergenic which can reduce and most time to no allergic reaction to babies. Their nutritional value is still comparable to standard formula (cow’s milk formula) and no impact on their development milestone. There are clinically proven for substitution of cow’s milk protein allergy babies. Some examples of milk powder which are extensively hydrolyzed are:
- Nutramigen® with Enflora™ LGG®* from Enfamil
- Similac Alimentum from Abbott
- Pregestimil from Enfamil
- Nutrilon pepti from Nutricia
- Profylac from Semper
2. Amino acid based milk – also known as elemental formula. Basically it is 100% broke down protein. No intact protein with only amino acid, a building block of protein to form the required protein needed for the growth and development of the babies. It is also hypoallergenic and the simpler amino acid structure making it easy to digest. Some examples of milk powder which are amino acid based formula are:
Usually no.1 & 2 type of baby milk formulas are very expensive and sometimes the taste is a bit unacceptable (noticeable bitter taste) by the babies.
3. Hydrolyzed rice protein formula – Has preliminary clinically studies on the efficiency of hydrolyzed rice protein formula which is designed to achieve similar amino acid profile to mother’s milk using rice. The study shows that hydrolyzed rice protein formula can also be used to replace cow’s milk. Since rice is cheaper, and its nutritional value is comparable to soy protein formula, it may become the first option in the treatment of cow’s milk protein allergy in the near future. Here is the examples of milk formula which are made from hydrolyzed rice protein formula:
- Novarice from Novalac
- Similac for spit-up from Abbott
Babies who are suffered from cow’s milk protein allergy have shown significant improvement by substitutions of cow’s milk formula.
Choosing the best formula for your babies can be overwhelming and complicated. Always consult your doctor to discuss about your concern regarding the babies condition before you make any alteration to the formula. Every baby are unique, choose the right formula will encourage their growth and development, somehow their comfort and tolerance are the first priority.
Please do not hesitate to drop me a comment if you have experienced cow’s milk protein allergy in your baby and do not mind to share here how you overcome it. It is always nice to share experiences so that all the moms will be benefited after reading this article.