How To Test For Milk Protein Allergy In Infants

Testing And Diagnosis Of Milk Allergy

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

If you suspect your child is allergic to milk, clinicians at Childrens Hospital of Philadelphia will take a detailed medical history of your child, including information on prior food reactions. Based on your childs history and findings, our clinicians may order one or more of the following tests:

Symptoms Of Anaphylaxis In Infants With Milk Allergy

Mostly all children and infants are allergic to certain things may be food, dust, etc. Whenever they fall in contact with them they develop symptoms such as shortness of breath and hives and it is known as an allergic reaction. These mild and severe symptoms can lead to serious allergic reaction known as anaphylaxis. The symptoms of anaphylaxis may occur when your infant becomes prone to allergy and this situation can get worse. Anaphylaxis must be treated immediately because it can cause death as well. Major symptoms are skin rashes and itching, swelling of the lips, tongue and throat, problem in breathing, dizziness or fainting, stomach ache with vomiting or diarrhea. So if your infant or child is prone to any king of allergy make sure to provide a better treatment to avoid extreme conditions like anaphylaxis.

General: Low Or No Weight Gain Or Failure To Thrive

Most infants double their birth weight by six months and triple it by 12 months. Each dot on a growth chart is a percentile. The dots form a growth curve that shows a pattern of growth relative to the population. A childs head circumference, weight, and height generally follow a consistent trend over time.

Sometimes though, slow weight gain may lead to a diagnosis of Failure to Thrive , which is one of the symptoms of a cow milk allergy. Slow weight gain is gaining weight more slowly than other children the same age and gender.

Many factors contribute to slow weight gain, and often several factors are at play. Food allergy reactions can cause problems digesting or absorbing food, leading to failure to thrive. For example, babies may not get the nutrition they need because of excessive diarrhea or vomiting. The body may not get all the nutrients needed, which can mean they cant grow as quickly as they should.

As always, ask your childs healthcare professional if you are concerned about your childs weight.

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What Is A Milk Protein Allergy

A milk protein allergy involves an immune response to ingesting milk protein. This response usually occurs right away after ingestion. A dairy intolerance or sensitivity differs from a true allergy in that an allergy triggers the immune system as well as digestive issues, while sensitivity to milk/dairy only causes digestive problems or discomfort.

Note that a cow’s milk allergy is not the same as lactose intolerance. A baby with an allergy to cow’s milk is reacting to the protein in dairy. Lactose is a type of sugar, not a protein. It’s very unusual for a newborn or infant to be sensitive to lactosean issue that is typically seen in adults or older children. For this reason, if your baby does have a milk allergy, lactose-free dairy products will still cause a reaction.

What Causes Cows Milk Allergy

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An allergy happens when the body’s immune system mistakes a harmless substance — in the case of food, a protein — as a foreign invader and attacks it, much like it would attack bacteria or a virus. This abnormal response releases chemicals that in turn trigger the symptoms associated with an allergy.

Milk contains both casein and whey , and each of these has several different proteins, any of which can cause an allergic response.

A cows’ milk protein allergy can cause different kinds of reactions, depending on the chemicals released, and the allergy is categorized based on these causes:

  • Immunoglobulin E -mediated reactions: The immune system releases histamine and other chemicals in response to cows’ milk protein. The symptoms usually occur within 20 to 30 minutes of consuming the protein, but they can appear up to 2 hours later.
  • Non-immunoglobulin E-mediated reactions: T cells are thought to be the trigger for the symptoms, which appear more gradually, from 48 hours up to a week after consuming cows’ milk protein.
  • Mixed IgE and non-IgE reactions: This is a combination of immunoglobulin E-mediated reactions and non-immunoglobulin E-mediated reactions.

A cows milk allergy should not be confused with lactose intolerance, a condition in which the body cannot produce enough of the enzyme needed to digest a type of sugar found in milk.


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How Is A Milk Allergy In Babies Treated

If it turns out that your newborn is one of the 2 to 3 percent of babies who has a milk allergy, dont despair. Many children outgrow a milk allergy by the time they’re around 1 year old, and the majority of babies with milk allergies outgrow the condition by about age 3.

In the meantime, your child’s doctor may recommend the following:

  • If your baby is formula-fed: Your pediatrician will suggest switching to a different formula. Because many babies with milk allergies are also allergic to soy , the doctor may suggest a hypoallergenic formula with hydrolysate protein, which has milk proteins that are already partly broken down, so its less likely to cause a reaction.
  • If youre breastfeeding or exclusively pumping: Your pediatrician will likely recommend that you ditch dairy in your diet to see whether that makes a difference to your baby. Of course, making a major change to your diet is probably the last thing you want to think about when dealing with a fussy newborn, but it may very well resolve the issue. If you do eliminate dairy, be sure to talk with your doctor about how to make sure youre still getting enough calcium and other nutrients in your diet.

Treatment With A Dairy

If you do need to eliminate dairy, there are many substitutes for cow’s milk and milk products available. Just look for dairy-free on the labels at the grocery store. Since milk is a known allergen, it must be identified on food labels. Remember that milk can be found in many different products, including soups, salad dressing, and baked goods.

Keep in mind that even though a reaction to cow’s milk is the more common one, soy and nuts can also cause allergies in breastfed babies. Also, you’ll need to be careful that you consume enough calcium from non-dairy sources in order to meet your nutritional needs.

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How Common Is Cma

CMA is a common childhood allergy, affecting 23% of children before the age of 3 years. Babies who have close family members with allergic conditions such as eczema and asthma are more likely to have CMA.CMA is less likely in babies who are only breastfed, as their only source of cows’ milk protein comes through their mother’s diet. This is associated with a lower risk of allergy.

What Is A Milk Allergy

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

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow’s milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like .

Cow’s milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.

People of any age can have a milk allergy, but it’s more common in young children. Many kids outgrow it, but some don’t.

If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction . An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

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Is Breastfeeding Safe In Babies With Cma

You can continue to breastfeed infants with CMA. Breastfeeding alone is the best source of nutrition for all babies until the age of 6 months. For babies older than 6 months, you need to slowly introduce solids because breastfeeding alone is not enough for growth and development. If possible, babies should continue to be breastfed until they are at least 12 months of age. For babies that are breastfed only, mothers should continue breastfeeding. Many women can continue to have cows milk or dairy in their own diet without affecting the baby, but some women will also need to avoid but must avoid any foods or drinks that contain cows’ milk products or dairy. Your doctor or dietitian can help make this decision. Mothers who are avoiding dairy may need help to make sure they are getting enough calcium.

If this does not resolve symptoms, or if breastfeeding is not possible or adequate, or if you wish to wean your infant before they are aged 12 months, ask your doctor or dietitian for advice on which infant formula to try.

What Infant Formulas Are Not Suitable For Cma

There are many other infant formulas available that are not suitable for CMA:

  • Partially hydrolysed formula the cows’ milk protein has been only partially broken down so can still cause an allergy. Examples include Karicare HA and Nan HA Gold Protect.
  • Goats milk, sheep milk, mares milk these animal milks are not suitable for children or adults with CMA as the proteins are very similar to those in cows’ milk and most people will react to these too.
  • Rice milk, oat milk, almond milk, cashew nut milk, coconut milk these plant-based milks are lower in energy, protein and fat. Some are fortified with calcium and B vitamins. Rice milk is not recommended for children under 5 years of age as the sole milk replacement because it does not meet their nutritional needs but can be used as a supplement with help and advice from a dietitian.

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Treatment Of Allergy To Cow’s Milk Protein

Modern adapted formulas are mostly made on the basis of the cow’s protein casein. If the baby is allergic to milk or lactose intolerant, they these compounds are not suitable. In this case, selects a mixture based on hydrolysis of the protein or the mixture, which is based on the amino acids.

Adapted infant formulas based on the hydrolysis of proteins: “Frisopep”, “Patikat”, “Al”, “Nutrilite stst”, “Nutrilite TSC”.

To prevent allergies, if necessary, and there is a risk of developing allergies, you can replace the usual mixture adapted mixture with partial splitting of the protein: “Nutrilon HA”, “HA Nutrilog 2”, “NAN HA 1 and NAN HA 2”.

When lactose allergies , it is advisable to use the following mixture: “Humana HA 1”, “Humana HA 2”, “nutrilac HA”, “HA HiPP 1 and the HiPP HA 2”.

Another alternative to cow’s protein mixtures are mixtures which are based on goat’s milk, such as NANNY. But not all believe that these compounds are worthy replacement, American pediatricians forbid if you are allergic to cow protein to use these mixtures, these mixtures include whole milk.

Should be excluded from the diet of baby fish, nuts and eggs if a child who is breast-feeding, there are allergic to cow protein. A month later the child will feel better. If there is no improvement, you should use a mixture based on protein hydrolysis, even if they do not help, then the best choice is a mixture, which is based on the amino acids.

Algorithm For The Diagnosis And Management Of Cmpa In Formula

How to spot Cow

Patients with life-threatening, particularly respiratory symptoms or anaphylaxis, conditions need to be referred immediately to an emergency department experienced in the treatment of this condition. In all the other situations, the initial step in the diagnostic work-up for CMPA is clinical assessment accompanied by history taking, including establishing whether there is a family history of atopic disease .

The algorithm differs according to the severity of symptoms . If the infant does not present alarm symptoms , the case is considered as mild-to-moderate suspected CMPA, and a diagnostic elimination diet should be initiated. Infants presenting with symptoms such as angio-oedema of lips and/or eyes, urticaria and immediate vomiting are likely to have IgE-mediated allergy. In the case of IgE-mediated allergy, improvement offers a safety net before challenge. A positive SPT increases the likelihood of a positive food challenge but not the severity of the reaction. In the study from Celik-Bilgili and coworkers, 60% of the patients with a RAST class 1, 50% in class 2, 30% in class 3 and even 20% in class 4 had a negative food challenge.

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If Your Child Has An Allergic Reaction

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.

Advice For Parents Worried About Their Child With Suspected Cmpa

As a pharmacist, it is important to consider CMPA as a possible diagnosis for infants with unresolved symptoms that do not respond to conventional treatment. If CMPA is suspected, parents should be advised to take their child to their GP. They should also keep a diary of ingestion of milk and record the onset of symptoms because this will help the diagnosis. Pharmacists should reassure parents that there are alternative milk substitutes available if their infant is diagnosed with CMPA and there are no associated long-term complications. Studies suggest that most children with non-IgE-mediated CMPA and IgE-mediated CMPA will be milk tolerant by the age of three and five years, respectively,. Reintroduction of cows milk using the milk ladder should be done under supervision of a healthcare professional, usually a dietitian. It may be useful to direct parents to national patient support websites .

Useful resources

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Treating A Milk Allergy

If your infant has a milk allergy and you are breastfeeding, its important to restrict the amount of dairy products that you ingest because the milk protein thats causing the allergic reaction can cross into your breast milk. You may want to talk to your doctor or a dietician about finding alternative sources of calcium and other vital nutrients to replace what you were getting from dairy products.

Since 2006, all food makers have been required to clearly state on package labels whether the foods contain milk or milk-based products, indicating this in or next to the ingredient list on the packaging.

If youre formula feeding, your doctor may advise you to switch to a soy protein-based formula. If your infant cant tolerate soy, the doctor may have you switch to a hypoallergenic formula, in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

Two major types of hypoallergenic formulas are available:

  • Extensively hydrolyzed formulas have cows milk proteins that are broken down into small particles so theyre less allergenic than the whole proteins in regular formulas. Most infants who have a milk allergy can tolerate these formulas, but in some cases, they still provoke allergic reactions.
  • Amino acid-based infant formulas, which contain protein in its simplest form . This may be recommended if your babys condition doesnt improve even after a switch to a hydrolyzed formula.
  • Not All Reactions To Cows Milk Are Due To Allergy To Cows Milk Protein

    BABY FORMULA ISSUES | Cow’s Milk Protein Allergy

    Lactose intolerance: This is caused by the lack of the enzyme lactase, which helps to digest the milk sugar called lactose. Symptoms include diarrhoea, vomiting, stomach pain and gas . This condition is uncomfortable but not dangerous and does not cause rashes or anaphylaxis. Allergy tests to cows milk are negative in people with lactose intolerance. Diagnosis is by temporary elimination of lactose and reintroduction.

    Milk, mucus and cough: Some people complain that when they drink cows milk or eat other dairy foods, that their throat feels coated and mucus is thicker and harder to swallow. Research has shown that these sensations occur with similar liquids of the same thickness and are not due to increased production of mucus.

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    Will My Infant Need Any Treatment

    If cows milk allergy is diagnosed, cows’ milk protein will need to be eliminated from your child’s diet.

    For breastfeeding moms, that means you cant have any dairy in your own diet. Cut out milk, butter, cheese, yogurt and ice cream, plus prepared foods that use dairy, like a lot of baked goods. Goats and sheeps milk have similar proteins to cows milk, so those products are off-limits too. Dairy can hide in processed foods under different chemical names, so check labels for:

    • Casein
    • Milk solids or milk sugar solids
    • Whey
    • Whey syrup sweetener


    Its hard to get enough calcium and vitamin D when you dont eat dairy. Talk to your doctor about adding other calcium-rich foods to your diet, or taking a supplement.

    If youre bottle feeding, your doctor can recommend an allergy-free formula:

    Extensively hydrolyzed formulas : About 90% of infants with a cows’ milk protein allergy can tolerate extensively hydrolyzed formulas. Although these are based on cows’ milk, so the nutrient content is the same as normal infant formulas, they have been extensively broken down into tiny parts so that the child’s immune system is less likely to recognize the protein.

    Amino acid formulas : If your child has trouble with a hydrolyzed formula, or has severe symptoms — such as severe skin or gastrointestinal symptoms or has had an episode of anaphylaxis — an amino acid formula may be recommended.

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