Cow’s milk allergy

Author: Kathy Beck, APD, Paediatric Allergy Dietitian

Cow’s Milk Allergy (CMA) is an allergic reaction to proteins found in cow’s milk, commonly affecting infants and young children. It is one of the most common food allergies in early childhood (approximately 2%) but can also affect adults.

There are two quite different types of cow’s milk allergy which present with different symptoms.

IgE mediated cow’s milk allergy is characterised by symptoms presenting within minutes to an hour or two after cow’s milk or other dairy products are consumed. Mild symptoms include swelling of lips, face and eyes, hives or welts, abdominal pain, vomiting and diarrhoea. Severe symptoms (anaphylaxis) include noisy breathing or wheeze, swelling or tightness in the throat or babies may become pale and floppy. This can be life threatening and is treated as a medical emergency requiring injection of an adrenaline autoinjector and urgent medical care.

Non IgE mediated cow’s milk allergy is a delayed reaction presenting hours to days after cow’s milk consumption. This type of cow’s milk allergy occurs in the first few months of life and include persistent irritability (colic), vomiting (reflux), frequent loose stools often with blood and / or mucous, in addition to eczema or a tendency to rashes.

All babies and young children with cow’s milk allergy should be assessed by an experienced GP, paediatrician or paediatric immunologist. Diagnosis is based on clinical history, skin and / or blood tests and oral food challenges under medical supervision.

Cow’s milk allergy is managed by exclusion of cow’s milk in the infant or child and sometimes in the breastfeeding mother. Cow’s milk contributes important nutrients necessary for growth and development in infants and young children, and optimal health outcomes in breastfeeding mothers and must be adequately replaced.

Referral to a paediatric dietitian who is experienced in food allergy is highly recommended for nutritional assessment and provision of a plan to ensure alternatives are included to ensure adequate intake of calcium, vitamin D, protein and fat. A paediatric dietitian will also monitor growth and make recommendations if growth is not optimal.

Many children start to outgrow non IgE mediated cow’s milk allergy by 12 months of age and the paediatric immunologist and / or paediatric allergy dietitian can supervise introduction using the cow’s milk ladder. Children with IgE mediated cow’s milk allergy can outgrow it by the time they start school and should be regularly assessed by a paediatric immunologist.

About the author

Kathy Beck is a South East Queensland based paediatric dietitian who specialises in food allergy. Kathy is an active member of the Dietitian’s Committee of the Australasian Society of Allergy and Clinical Immunology (ASCIA). Kathy has been a dietitian for over 30 years with the last 15 years working in paediatrics in various clinical settings in Australia and England.