Cow’s milk protein allergy – part 1

Cow’s milk protein allergy (CMPA) is one of the most common food allergies in infants and young children, affect 1.9 5to 4.9% of children under the age of one. Most children can outgrow CMPA by the age of five years.

In a two part series of blogs, we will provide some background on allergies and details about CMPA and how to manage it through a change in diet and finding alternatives.


Understanding allergies 

Allergies can be Immunoglobulin E(IgE) mediated or ‘immediate’ or non IgE mediated ‘delayed.

An immediate reaction  to cow’s milk could be a symptom such as wheezing, rash, vomiting or anaphylaxis, where as a  delayed reaction can occur up to 72 hours after milk has  been ingested . Delayed reactions can vary, but usually include gastrointestinal symptoms such as loose, frequent stools, reflux or colic.


How do I find out if my child has a CMPA ? 

If you think that your child may have a cow’s milk allergy, it is important to discuss this with your child’s pediatrician, where they should take an allergy focused history. Recording your child’s food and drink intake and symptoms for 3 days before the appointment will be very beneficial in helping your doctor diagnose if there are any issues.


What is the management for CMPA?

If they identify from your child’s intake and symptoms that your child possibly has a CMPA they will advise the cow’s milk proteins be removed from your child’s diet for 2-3 weeks. During this time your child’s symptoms should improve, if they do not your child may have allergies to another food or environmental trigger (e.g cat / dog hair, dust mites etc) and therefore you may need further advice or tests. It is important to work with your health care team to help find out what is causing the reactions and to avoid unnecessary dietary exclusion.  To support you in any dietary exclusion, the doctor should recommend a referral to a dietitian.


Do I need to stop breastfeeding if my child has a CMPA? 

Cow’s milk protein ingested by the mother can pass through the breastmilk to the infant. It may depend on how severe the reactions are, but a mother can usually continue to breastfeed successfully if she restricts cow’s milk from her diet.

In children where the reactions are severe, the child may be started on a cow’s milk free formula for a few days while the mother commences a milk free diet,  and expresses her milk before she resumes breastfeeding.  Mothers who are on a milk free diet should supplement their diet with 1000mg of calcium and 10mcg of vitamin D every day.


What cow’s milk free formulas are available? 

Children who are formula fed , should trial (2-3 weeks)  a cow’s milk free formula/ hypoallergenic formula . These are formulas where the protein has been broken down , or digested so that they don’t cause a reaction.

There are three different types of hypo allergenic formulas on the market.  The partially hydrolyzed or ‘HA’ formulas, the extensively hydrolyzed (eHF) formulas and the amino acid formulas (AA).

The HA formulas have only a small percentage of the proteins broken down and are  intended to prevent a child from getting an allergy , especially if there is a strong family history of allergies.

If your child has severe reactions, HA formulas will not be appropriate.  Most children tolerate extensively hydrolyzed formulas, however many of these products use pork trypsin to break down the proteins , except for a couple of products and are therefore not readily available in Qatar.

The third type is the amino acid formulas, where the proteins are broken down completely to their basic form. These are very successful in treating CMPA, but are very expensive and are often only available from the hospital.