Knowledge Centre Posts Cow’s Milk Protein Allergy

Cow’s Milk Protein Allergy

2nd September 2024

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A cow’s milk protein allergy (CMPA), also known as cow’s milk allergy (CMA), is a common food allergy in babies, affecting about 7% of infants under one year old. But thankfully, for most children, this is a ‘childhood allergy’ that is outgrown in the first decade of life.

This allergy develops when the immune system reacts to proteins in cow’s milk, this being mainly casein and whey. This is different from lactose intolerance, which is about difficulty digesting the sugar in milk.

Types of Cow’s Milk Protein Allergy

There are two main types of cow’s milk allergy based on how the immune system reacts:

IgE-Mediated Allergy

  • Triggered by the IgE antibody.
  • Symptoms appear quickly, usually within minutes to two hours after drinking cow’s milk.

Non-IgE-Mediated Allergy

There are many types of non-IgE reactions that con occur to milk protein; these include:

  1. Cow’s milk protein induced enterocolitis – in this condition fresh blood is noted in the infants stools, this can come about even in breast fed babies if mom is drinking cows milk or eating dairy. Allergy tests will be negative. This condition is typically outgrown in the first year of life.
  2. Food Protein Induced Enterocolitis – in this condition, profuse repetitive vomiting occurs some 2 or more hours after ingestion. The child may also appear floppy and pale. This resolves spontaneously after a few hours. Allergy tests will be negative. This condition is also typically outgrown in the first year of life.
  3. It may be that milk exposure induces one or more of the following non-specific symptoms – GI discomfort, reflux and eczema flares. Symptoms show up later after exposure, typically between two hours and three days after consuming cow’s milk. Allergy tests will be negative. These conditions are outgrown. Diagnosis is through supervised elimination re introduction dietary trials.

Symptoms of IgE-mediated Cow’s Milk Allergy

Symptoms of cow’s milk protein allergy often shows up in the first few weeks or months of a baby’s life and can affect different parts of the body, including the skin, digestive system, and sometimes the respiratory system.

Common symptoms of Cow’s Milk allergy include:

  • Skin reactions: Hives, eczema, redness, or itching.
  • Digestive issues: Vomiting, diarrhoea, stomach pain, or discomfort.
  • Respiratory symptoms: Sneezing, runny nose, coughing, wheezing, or trouble breathing.
  • General discomfort: Fussiness, irritability, and refusal to feed.

Reactions can range from mild to severe. Severe cases can lead to anaphylaxis, a serious, life-threatening reaction that requires immediate medical help.

Diagnosing cow’s milk protein allergy

If you think your child might have a cow’s milk allergy, talk to your doctor or allergist. They will ask a variety of questions to see if an allergy might be the cause of the symptoms and decide if allergy testing is needed; this may include one or more of skin testing, IgE blood testing, oral food challenge tests.

Allergic reactions are likely to also occur to the other mammalian milks, especially goat milk. If an infant milk formulae is required this should be a hypoallergenic milk as advised by your health care practitioner.

What are the chances of outgrowing Cow’s milk protein allergy?

Many children do outgrow a milk allergy as they get older:

Delayed Milk Allergies

  • Often outgrown within the first one to three years

Immediate Type Milk Allergies

  • Usually outgrown in first decade. Tolerance will first develop to processed forms of food where the allergen is damaged though cooking, e.g., biscuits.

Milder Immediate Allergies

  • About 80% of children with milder symptoms and positive allergy tests often outgrow the allergy by ages four or five.

Severe and Persistent Cases

  • About 20% of children have a more serious allergy, with symptoms that may last longer. However, many of these children may outgrow it by age 16, so regular testing is important.
  • Milk allergy in older children can result in severe reactions, so it is important that such patients are educated and skilled at identifying and avoid milk protein as well as treating any allergic reactions as per their Allergy Action Plan.

Understanding these factors helps manage expectations and guides future testing for children with milk allergies.

What is Food OIT?

Food OIT, also known as food immunotherapy or oral desensitisation, is a treatment to help children become less sensitive to a food they are allergic to. It works by slowly giving them small amounts of the food, gradually increasing the amount over time. The aim is to help them handle more of that food, like milk, without having an allergic reaction. This means they can safely eat foods with that allergen or handle accidental exposure to small amounts.

However, it’s important to understand that this treatment usually only leads to a temporary improvement. The child can eat more of the allergen without reacting, but it doesn’t mean they are permanently immune, and to keep this temporary improvement, they need to keep eating the allergen regularly. If they stop, the risk of an allergic reaction might come back.

Would Food OIT be suitable for my child?

Food OIT isn’t suitable for every child. If your child has had severe allergic reactions, especially to tiny amounts of milk, or has poorly managed asthma or other health issues, OIT might not be the right choice. If your child’s allergy test results are very high (like a skin test larger than 9mm or IgE above 50), there’s a higher risk of side effects and less chance of success. OIT also requires daily dosing, so it’s important to be very consistent.

Lastly and not forgetting that this form of treatment will be more suited to those children who are less likely to have their allergy outgrown in childhood.

Appointments and enquiries:

The Allergy Centre of Excellence is founded by three internationally recognised Professors in Paediatric Allergy, (Professors Fox, Lack and Du Toit), and our aim is to provide patient centred and individualised care to children with food allergies and their families. We are supported by the most experienced clinicians and a wider patient services team to ensure you are supported at every stage of your allergy journey.

If you are interested in learning more about Food OIT or have any questions, please do get in touch.  You can fill out the short form on our Get in Touch – Allergy Centre of Excellence page, or give us a call at 020 3633 9851.

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