Cow’s Milk Protein Allergy

17 Feb

Cow’s Milk Protein Allergy (CMPA) is a type of food allergy common amongst babies and young children. Children with CMPA will have a reproducible allergic reaction to one or more of the proteins in cow’s milk. Essentially, a child’s immune system is getting it wrong and marking something typically safe (in this case, milk protein) as an unwanted invader, and as such, when the immune system is exposed to cow’s milk protein, an allergic reaction happens.

Types of Cow’s Milk Protein Allergy

There are different types of Cow’s Milk Protein Allergy, which generally can be classified as immediate or delayed, according to symptoms (which relate to the immune response)

1. Immediate reactions (IgE-mediated) generally occur within 2 hours of ingestion of cow’s milk protein, and symptoms may include a rash (like hives), swelling, itchy eyes, vomiting, and/ or rarely breathing difficulties.

2. Delayed reactions (Non-IgE mediated) are where symptoms occur between 2 and 72 hours after ingestion of cow’s milk protein. Symptoms may include changes in bowel habits like diarrhoea, blood or mucus in a baby or child’s poo, reflux, profuse vomiting, nausea, tummy, bloating, and/ or eczema. This type of allergy can be difficult to diagnose, as many symptoms crossover with other conditions common in babies and young children.

Cow’s Milk Protein Allergy, is often wrongly confused with lactose intolerance. Lactose intolerance is rare in babies and young children, and occurs when there is difficulty digesting the sugar (lactose) in milk. Remember milk allergy is a reaction to the proteins in cow’s milk.

When does a child show signs of Cow’s Milk protein allergy?

Typically, Cow’s Milk Protein Allergy presents in the early weeks and months of life. Research shows that exclusive breastfeeding little ones in the first 6 months of their life reduces their risk of developing CMPA. This is associated with the immune-modulating elements found in breast milk that have been found to reduce the risk of atopic diseases including allergy. Recent guidance also recognises that early formula milk top-ups (e.g. in the first few hours and days after birth), which are discontinued as a baby goes on to exclusively breastfeed, may increase a baby’s risk of developing Cow’s Milk Protein Allergy.

CMPA will also often presents earlier in babies who receive formula milk. This is because formulas can expose them to the whole milk protein, compared to babies who are exclusively breast fed, where the milk protein is reaching mum’s breast milk in a very well ‘broken down’ form, making it less likely for them to react to it. Despite this, some little ones are very sensitive to cow’s milk protein, and can show CMPA symptoms even when breastfed.

Cow’s Milk Protein Allergy Prognosis

It is estimated that 2-3% of 1–3-year-olds in the UK have CMPA (Allergy UK., 2017). Most present with suspected mild-to-moderate non-IgE CMPA, and, approximately 80%, outgrow their milk allergy by 3 years (Venter et al. 2007). Even in children who still get symptoms once they are older, they can often tolerate some milk protein in their diets.

If you think your baby has Cow’s Milk Protein Allergy, contact your GP for support. We also see babies with suspected CMPA or diagnosed CMPA regularly in our clinic, to offer support for everything from milk free feeding, weaning and allergen introduction, to the milk ladder.

Cow’s Milk Protein Allergy in a Sibling

There is no need to avoid allergens in siblings of children with food allergies unless the second sibling is exhibiting symptoms of a food allergy too. There are some practical considerations to bear in mind however if one or more of your children have confirmed food allergies in order to avoid cross contamination and accidental allergen exposure for example:

Using different coloured chopping boards when preparing a food with an allergen in it

Cleaning kitchen utensils before each usage
Washing hands thoroughly between preparing dishes
Storing ingredients and prepared foods with allergens in closed, separately, and in labelled containers

More guidance regarding management of allergens including avoiding cross-contamination is provided by the Food Standards Agency, HERE.

resources

The National Health Service offers more information about allergies, including a page on what to do if you think your little one has an allergy or intolerance to cow’s milk protein, which can be accessed HERE.

Allergy UK is a British medical charity dedicated to helping adults and children with allergies. They offer plenty of information, and support to people and families with allergies, including for cow’s milk protein allergy HERE.