How To Test For Cows Milk Protein Allergy

If Your Child Has An Allergic Reaction

Allergy Tests to Diagnose Cow’s Milk Protein Allergy (CMPA)

If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.

If your child has symptoms of a serious reaction :

  • Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
  • Then, or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

Take This Quick Cows Milk Allergy Test To Help Gather Information About Your Babys Symptoms And To Print And Share With Your Pediatrician

Take this cows milk allergy test by answering this series of 17 questions about the issues your baby is experiencing. Our milk protein allergy test for infants will help you gather information about your babys issues and talk to your pediatrician about whether a hypoallergenic infant formula, like Nutramigen, is the right choice for your little one. Select either Never, Sometimes or Often from the multiple-choice answers below each question.

Avoiding A Milk Allergy Reaction

If You’re Breastfeeding

If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.

If You’re Formula Feeding

If you’re formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

You also might see “partially hydrolyzed” formulas, but these aren’t truly hypoallergenic and can lead to a significant allergic reaction.

If you’re concerned about a milk allergy, it’s always best to talk with your child’s doctor and work together to choose a formula that’s safe for your baby.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy are not safe for infants.

If you have any questions or concerns, talk with your child’s doctor.

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How Is A Milk Allergy Diagnosed

If you think your infant is allergic to milk, call your baby’s doctor. He or she will ask you questions and talk to you about what’s going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist .

The allergist might do skin testing. In skin testing, the doctor or nurse will place a tiny bit of milk protein on the skin, then make a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area like an insect bite.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Management Of Cows Milk Allergy Involves Excluding Dairy Foods From The Diet

Algorithm for the diagnosis and management of cows milk ...

Management of cow’s milk allergy involves excluding cow’s milk and other dairy foods from the diet, unless otherwise recommended by your doctor. Most people who are allergic to cow’s milk will be allergic to other animal milks and foods that are made from these milks. To exclude cows milk and other dairy foods it is important to read all ingredient labels and exclude any food which contains these milks, unless otherwise advised by your doctor.

Cooked or baked cows milk in muffins, cakes or biscuits are tolerated by some people with cows milk allergy. However, unless you are already certain that cooked or baked cows milk is tolerated you should discuss this with your clinical immunology/allergy specialist before introducing these foods at home.

All people with food allergy should have an ASCIA Action Plan to help manage an allergic reaction. Some people with cows milk allergy may be prescribed an adrenaline autoinjector by their doctor.

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Rapid Onset Allergic Reactions To Cows Milk And Other Dairy Foods

Rapid onset allergic reactions usually occur within 15 minutes and sometimes up to two hours after consuming cow’s milk or other dairy foods. Symptoms include one of more of the following:

  • Mild or moderate allergic reactions such as hives , swelling of the lips, face or eyes, stomach pain, vomiting and diarrhoea.
  • Severe allergic reactions include noisy breathing or wheeze, tongue swelling, throat swelling or tightness, hoarse voice, loss of consciousness and floppiness in babies or young children. Anaphylaxis should always be treated as a medical emergency, requiring immediate treatment with adrenaline and calling for an ambulance.

Diagnosis of allergic reactions is usually obvious if symptoms occur soon after consuming cows milk or other dairy foods. This can be confirmed by your doctor after taking a medical history and using allergy tests.

Allergy tests that measure allergen specific antibodies called Immunoglobulin E to cows milk are usually positive for rapid onset reactions. There is no place in the diagnosis of cows milk allergy by unproven tests such as IgG, Vega, kinesiology, Alcat or allergy elimination tests.

Milk Allergy Vs Lactose Intolerance

The difference between a milk allergy and lactose intolerance is the involvement of the immune system. When a child has a milk allergy, the bodys immune system creates IgE antibodies to milk protein which lead to release of histamine and other chemicals that cause symptoms typical of allergic reactions

Lactose intolerance, on the other hand, involves more of the GI system. Those with lactose intolerance lack an enzyme that breaks down the sugars in milk and dairy products. This causes GI symptoms that may include nausea, cramps, gas, bloating and diarrhea.

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Skin Prick And Blood Tests

If a healthcare professional suspects that a baby might have IgE-mediated cows milk allergy, they may carry out a skin prick or blood test as part of the diagnosis process.

To support the diagnosis of IgE-mediated cows milk allergy, there are a couple of different tests to diagnose cows milk allergy that may depend on the type of allergic reaction that was suspected.

Skin prick test

The skin prick test involves exposing the babys skin to a tiny amount of cows milk protein, and carefully monitoring for any signs of an allergic reaction. If a reaction occurs it will appear as a small red bump at the site. The test will give results within 15-20 minutes that will be interpreted by the healthcare professional alongside the babys medical history and other factors.

Blood test

A blood test might be carried out to help diagnose IgE-mediated cows milk allergy by seeing whether the baby has any antibodies against cows milk protein in their blood. If they do, this might suggest that an allergic reaction is occurring in response to cows milk protein.


Its important that these tests are carried out by a healthcare professional. Dont buy any tests to use yourself as they may not be reliable and the advice they give may not be appropriate for your baby. Also, be aware that a positive skin prick test or a positive blood test does not confirm allergy as it only shows sensitisation to a food allergen.

The Two Types Of Allergy To Cows Milk

The First Steps to Diagnosing Cow’s Milk Protein Allergy (CMPA)

There are two kinds of cows milk allergy. One of them is mediated through a type of immunoglobulin called IgE, which causes classic food allergy. This kind is easier to diagnose, as children have more classic symptoms of allergy such as rashes, facial swelling, or flushing. There are also blood tests that can help make the diagnosis.

The other kind is not mediated through IgE, and is tougher to diagnose with certainty.

Babies with non-IgE mediated cows milk allergy can have various symptoms, such as vomiting, fussiness during or after feeding, diarrhea, or blood in the stool. The problem is that lots of babies without allergy can have vomiting, fussiness, or diarrhea and there are other reasons why babies might have blood in the stool, including having a small cut in the anus. The only way to definitively diagnose non-IgE mediated allergy is to eliminate all dairy, see if the baby gets better and then reintroduce dairy again and see if the symptoms come back.

For lots of understandable reasons, many doctors and parents dont want to do that reintroduction once a baby gets better but the baby getting better may have nothing to do with the diet change.

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What Are The Signs & Symptoms Of A Milk Allergy

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

  • wheezing
  • swelling
  • a drop in blood pressure causing lightheadedness or loss of consciousness

The severity of allergic reactions to milk can vary. The same child can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.

Children also can have:

  • an intolerance to milk in which symptoms such as loose stools, blood in the stool, refusal to eat, or irritability or colic appear hours to days later
  • lactose intolerance, which is when the body has trouble digesting milk

If you’re not sure if your child has an intolerance versus an allergy, talk to your doctor.

What To Do If You Are Intolerant To Cows Milk Protein

If casein comes up as something to avoid, all dairy, including goat and sheep milk products should be avoided for 3 months. Goat and sheep milk is naturally homogenised so often easier to digest but ultimately they have a similar protein to that of cows milk.

Its important to record your symptoms in a food, mood and symptom diary so you can pinpoint reactions easily. Improvement is often seen within a month, but relief often comes quicker.

You should aim to be completely symptom-free for three months before reintroduction of intolerant foods. Reintroduction should happen gradually, starting with reintroducing one food once a week and building up to every other day. If symptoms return then food should be removed again for another month. It might be that you cannot tolerate cows milk and you need to avoid or take lactase if you eat or drink something containing it.

Look out for the following on ingredients labels and avoid:

  • Butter

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What Is A Milk Allergy

A milk allergy occurs when a childs immune system mistakenly recognizes cows milk protein as a foreign invader. Milk allergies are most common in infants and young children.

Children who have a milk allergy will typically show symptoms immediately, within minutes and up to 2 hours of consuming milk or products containing milk proteins. Milk is among the foods most likely to cause anaphylaxis, a life-threatening allergic response. Other symptoms may include difficulty breathing, nausea and hives.

Cows milk is the most common milk allergen, but children can also have allergic reactions to milk from other animals, including goats and sheep.

About 2.5 percent of children younger than 3 years old are allergic to milk. However, most children outgrow their milk allergy.

Foods: What’s Allowed And What’s Not



  • All milks
  • Yogurt, eggnog, milkshakes, malts
  • All beverages made with milk or milk products


  • Wheat, white, rye, corn, graham, gluten and soy breads made without milk or milk products
  • Graham cracker and rice wafers

Not allowed:

  • Wheat, white or rye breads that contain milk
  • Biscuits, donuts, muffins, pancakes, waffles, zwieback, crackers, saltines that contain milk. There are now several mixes available that do not contain milk. Be sure to carefully read labels.
  • Most commercially prepared breads and rolls contain milk or milk products
  • French toast made with milk


  • Any cereal to which no milk or milk products have been added

Not allowed:

  • Prepared and precooked cereals with milk solids, casein or other milk products added


  • Meringue, gelatin, popsicles, fruit ice, fruit whip and angel food cake
  • Cakes, cookies and pie crusts made without milk or milk products such as Vegan desserts

Not allowed:

  • Cake, cookies, custard, pudding, cream desserts or sherbet containing milk products
  • Ice cream, cream pie
  • Scrambled with milk, creamed eggs or egg substitutes


  • Vegetable oil, meat fat, lard, bacon, shortening, milk-free gravy
  • Peanut butter
  • Salad dressing or mayonnaise containing milk, milk solids or milk products
  • Some butter substitutes and nondairy creamers


  • Fresh, frozen or canned fruits and juices

Not allowed:

  • Any fruits served with milk, butter or cream such as whipped cream

Meats, fish, poultry and cheese


Not allowed:

Not allowed:


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What Is Cow’s Milk Protein Allergy

Cow’s milk protein allergy is an allergic condition which is triggered by drinking cow’s milk or by drinking or eating products made from cow’s milk.

It can cause:

  • Skin symptoms, such as rashes and eczema
  • Gut symptoms, such as feeling sick , being sick and abdominal pain
  • Breathing symptoms, such as a runny nose and wheezing.

The symptoms are often vague and sometimes it is very difficult for a definite diagnosis to be made.

Cow’s milk protein allergy occurs in about 7% of babies who have formula milk, but in only about 0.5% of exclusively breast-fed babies, who also usually have milder reactions. Exclusive breast-feeding may also protect babies from developing an allergy to cow’s milk protein after they are weaned.

Cow’s milk protein allergy is more likely in children who have other allergic conditions such as asthma, eczema or hay fever, or if close family members have those conditions.

Points De Repre Du Rdacteur

  • Lallergie aux protéines du lait peur survenir durant lallaitement au biberon ou durant lallaitement maternel, habituellement avant lâge dun an. Les manifestations initiales peuvent être cutanées , mais elles peuvent aussi être dordre respiratoire, digestif ou nutritionnel. Certains nourrissons présentent dabord des pleurs irréductibles et refusent toute nourriture.

  • Lhistorique permet de soupçonner une allergie aux protéines du lait. Les investigations possibles incluent la provocation alimentaire, le prick-test, la mesure du taux sérique des anticorps IgE spécifiques et lépidermoréaction.

  • Le traitement cherchera principalement àéviter lallergène tout en maintenant un régime nourrissant et équilibré, pour le nourrisson comme pour la mère lallaitement au sein peut être poursuivi si la mère évite les allergènes. Le poids du bébé doit être étroitement surveillé.

  • Lallergie aux protéines du lait peut être traitée avec succès en soins primaires avec le soutien dune diététicienne les autres spécialistes ne devraient être consultés quen cas dallergie sévère ou déchec du traitement standard et quand des tests dallergie spécifiques sont indiqués.

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How Cows Produce Milk

A cows special four-chambered stomach breaks down grasses she eats into things that nourish her and produce milk. The first chamber softens chewed plant material, which the cow burps up and chews again several times. There, special cells combine the nutrients with sugars from the cows liver to create milk.

How To Identify And Deal With A Milk Protein Intolerance

COW’S MILK PROTEIN ALLERGY – Should we test for it?

Milk protein or casein intolerance occurs when the body has a food-specific IgG antibody response to the protein found in milk. This is not to be confused with lactose intolerance, which occurs wheninsufficient amounts of lactase are produced by cells in the small intestine.

If lactose is not broken down into smaller, simpler forms that can be absorbed into the bloodstream, a myriad of digestive symptoms may occur, including bloating, diarrhoea, cramps and flatulence.

IgG-mediated cows milk protein intolerance should also not be confused with an IgE mediated allergy, which is more common in those with an atopic or allergic disposition. IgE allergies cause a fast body reaction, often 2 hours or less after exposure. The easiest way to test for allergies is using a RAST test, commonly offered by your GP.

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Treatments For Milk Allergy

Once your child is confirmed to have a milk allergy, the first step in treatment is avoiding milk and dairy products.

Your childs doctor can give you detailed information on how to read food labels to help you identify and avoid milk protein.

No matter how careful you are, there may be times when your child accidentally ingests milk protein and has a reaction. When that happens, you can treat the symptoms with antihistamines or epinephrine.

If more than one body system is involved in the allergic reaction for example the throat and skin it is recommended to use epinephrine. Epinephrine comes in a variety of forms, including auto-injectors such as Epi-Pen, Auvi-Q and other generic forms.

If your childs reaction is mild and only involves a few hives, an over-the-counter or prescription strength antihistamine can ease their symptoms. Your childs doctor can help you decide which option is best for your child in each circumstance.

Children with milk allergies should carry epinephrine with them, or it should be readily available at places where they routinely spend time, such as school, daycare and home.

Cow’s Milk Protein Allergy

In this series

Cow’s milk protein allergy is one of the most common food allergies seen in children. It is most commonly seen during the first year of life. Many children who have been allergic to cow’s milk protein become tolerant to it by the time they are 5 years old.

In this article

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Cows Milk Allergy Is Uncommon

According to a special communication published in JAMA Pediatrics, while 14% of babies are reported to have cows milk allergy, only about 1% actually do have it.

As for the diet restrictions for breastfeeding mothers, the authors report that those are likely not necessary, even if there is an IgE-mediated allergy. So many mothers are putting their nutrition at risk, or stopping breastfeeding, for no good reason.

Its also worrisome that in 81% of the published guidelines on cows milk allergy, the authors of the guidelines reported a conflict of interest with formula manufacturers. This does not mean that the guidelines arent good or accurate, but its troubling that the formula manufacturers are supporting so much of the research.

If your baby has been diagnosed with cows milk allergy, and you have changed your babys diet or your own, dont stop these changes without talking to your childs doctor. But definitely talk to the doctor, and be sure that you understand exactly why your baby has the diagnosis and whether any further evaluation makes sense.

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