Cow's milk allergy / intolerance (CMA/I) affects mainly babies and young children. An allergy occurs when the immune system "over reacts" to the protein found in milk whereas a cow's milk intolerance is a reaction to milk which may or may not involve the immune system.
Cow's milk and hen's eggs are frequently the cause of allergic reactions in the first year of life. Soya can also be an allergen1.
CMA/I is typically characterised by symptoms such as eczema, itchy skin, persistent diarrhoea, repeated vomiting or possetting, refusal to eat and colic. A baby may have one or more of these symptoms. Sometimes symptoms are delayed and occur a number of hours after eating the food, making diagnosis more difficult.
Food allergies often occur in association with atopic eczema, an inflammatory skin condition. About 50-60% of all infants with atopic eczema also suffer from cow's milk allergy which can significantly worsen the condition of the skin2,3.
A baby is at higher risk of developing atopic eczema if there is a family history of allergic (atopic) symptoms, that is, if one or both parents have conditions such as asthma, atopic eczema or hay fever.
Breastfeeding is the best choice of feeding for any baby, but it offers even more protection for babies who are at risk of developing food allergies. Breast milk contains protein from the mother which is well tolerated by the baby. It also contains special ingredients that protect the immature gut from foreign substances such as food protein. If you cannot or choose not to breastfeed, and your baby is at high risk of developing atopic eczema, a hypoallergenic formula is recommend to reduce the risk of allergy4-6. Soya formula has not shown any benefit in reducing the risk of atopic eczema7,8.
If your doctor diagnoses a CMA/I, it is important to remove all sources of cow's milk and milk products from your baby's diet. If you are breastfeeding ask your healthcare professional if you should eliminate milk and milk products from your diet and how you are able to ensure an adequate supply of calcium and other nutrients. If your baby is bottle fed and sensitive to cow's milk protein, it is recommended that a milk based formula should be replaced with an extensively hydrolysed hypoallergenic formula or an amino-acid based formula if your child is very sensitive or has an allergy to a number of foods1. Soya formula is not recommended for the first-line treatment of infants with CMA/I9.
Fortunately, most babies with a CMA/I do not require a milk-free diet for life. Recovery from an allergy is often slower than from an intolerance, however most children grow out of their allergy between 1-4 years of age. Your healthcare professional will check from time to time if your baby still requires a milk-free diet. It is important that you consult your doctor or dietician before introducing cow's milk into your child's diet.
Although your child cannot tolerate cow's milk and cow's milk products, they need a suitable alternative formula to provide all the nutrients needs for growth and development.
Many health food shops and supermarkets sell cartons of soya milk. These are not suitable for a standard infant formula as they are not nutritionally complete and they should not be given to babies and young children under 2 years.
1. Host A et al. Arch Dis Child 1999; 81:80-84.
2. Isolauri E. J R Soc Med 1997; 90 (Suppl 30)15-20.
3. Isolauri E. et al. J Allergy Clin Immunol 1996; 97:9-15.
4. Oldeaus G et al. Arch Dis Child 1997;77:4-10.
5. Halken S et al. Pediatr Allergy Immunol 2000;11:149-161.
6. Berg A von et al. J Allergy Clin Immunol 2003;111:533-540.
7. Zeiger R. J R Soc Med 1997; 90(30); 21-33.
8. American Academy of Pediatrics, Committee on Nutrition. Pediatr 1998;101(1):148-153.
9. CMO's Update 37.Department of Health. January 2004.