Cow's milk allergy in babies affects 1 to 3% of all babies [1-3] and can lead to various symptoms. If you consume cow's milk as a breastfeeding mother, the milk proteins can be passed on to your baby through breast milk. Cow's milk protein allergy is notably less common in breastfed babies (0.5%) than in formula-fed babies [3, 4]. It's important to recognise and understand the symptoms, though this can sometimes be tricky given how much they can vary [2, 5]. In this article, we cover the symptoms, causes, and diagnosis of cow's milk allergy in babies.
What is cow's milk allergy?
With a cow's milk allergy, your baby's immune system reacts strongly to the proteins present in cow's milk. Normally, the immune system targets unwanted invaders such as bacteria and viruses, but in children with a cow's milk allergy, it also targets these milk proteins. This can cause symptoms that are genuinely uncomfortable for your little one. Cow's milk allergy is often diagnosed within the first four months of life. A large proportion of children grow out of it over time, usually by their third birthday [1, 2, 6].
Did you know this is the most common food allergy in babies? [3] Unfortunately, this allergy brings uncomfortable symptoms with it, which aren't always easy to recognise.
Causes of cow's milk allergy
Often, no specific cause can be identified for the development of a cow's milk allergy. Genetic predisposition can, however, play a role in developing allergies, including cow's milk allergy. If allergies run in the family, this can increase the risk for your little one [6].
Symptoms of cow's milk allergy in babies
The following symptoms can occur anywhere from a few minutes to around two hours after drinking cow's milk, and may indicate a cow's milk allergy:
- Itching, eczema, and/or hives
- Colic/cramping
- Vomiting
- Constipation and/or diarrhoea
- Wheezing or laboured breathing
[2, 3]
The severity of symptoms can vary widely, and this list isn't exhaustive - your baby could show very different symptoms and still have a cow's milk allergy. For this reason, a cow's milk allergy should always be diagnosed by a doctor. Think your baby is reacting strongly to their milk feeds? Always contact your health visitor or doctor [3].
Impact on baby's development
Cow's milk allergy can affect a baby's development, and can lead to issues such as undernutrition or slower growth. Suspect a cow's milk allergy? Always consult your health visitor or doctor. They can assess the symptoms, refer you to a doctor or specialist for diagnosis, and if needed refer you to a dietitian for tailored advice on the best (dietary) treatment for your baby [5-7].
Diagnosing cow's milk allergy
Reaching a diagnosis can take some time. A doctor will usually discuss the symptoms, when they started, what your baby drinks (and possibly already eats), and will also ask about allergies in the family and general health. Various tests can help with diagnosis, including blood tests, skin tests, and double-blind food challenge tests [1, 3, 5, 8].
With a medically diagnosed cow's milk allergy, it's important to avoid cow's milk proteins. A doctor or dietitian can help you find suitable nutrition for your baby [1, 3]. Important to know: goat milk formula is also not a suitable alternative for a medically diagnosed cow's milk allergy, due to the significant risk of a cross-reaction [7, 9]. However, if it's not an allergy but a cow's milk intolerance, goat milk formula can be a suitable alternative [10].
Tips for parents
Dealing with a baby with a food allergy can be challenging. A few general tips:
- Follow the advice of the specialist and/or dietitian.
- Don't experiment yourself with eliminating suspected foods - the risk of deficiencies in important nutrients for your baby is significant [3, 6].
- Learn to read food labels to recognise the allergen or traces of it.
- Communicate with childcare staff and other caregivers about the allergy and how to manage it.
- Be prepared for emergencies by always keeping an action plan and any medication on hand.
- Seek support from other parents of children with food allergies.
References:
- Koletzko, S., Niggemann, B., Arato, A., Dias, J.A., Heuschkel, R., Husby, S., Mearin, M.L., Papadopoulou, A., Ruemmele, F.M., Staiano, A., Schäppi, M.G., Vandenplas, Y. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr, 2012; 55.
- D'Auria, E., et al. Cow's Milk Allergy: Immunomodulation by Dietary Intervention. Nutrients, 2019; 11(6).
- Lifschitz, C. and Szajewska, H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr, 2015; 174(2): p. 141-50.
- Mehaudy, R., et al. Cow's milk protein allergy; new knowledge from a multidisciplinary perspective. Arch Argent Pediatr, 2022; 120(3): p. 200-206.
- van den Hoogen, S.C.T.A., et al. Suspected cow’s milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence. BMC Research Notes, 2014; 7(1): p. 507.
- Flom, J.D. and Sicherer, S.H. Epidemiology of Cow's Milk Allergy. Nutrients, 2019; 11(5).
- Arasi, S., Cafarotti, A., and Fiocchi, A. Cow's milk allergy. Curr Opin Allergy Clin Immunol, 2022; 22(3): p. 181-187.
- Vandenplas, Y., et al. Algorithms for managing infant constipation, colic, regurgitation and cow's milk allergy in formula-fed infants. Acta Paediatr, 2015; 104(5): p. 449-57.
- Rodríguez del Río, P., et al. Allergy to goat's and sheep's milk in a population of cow's milk-allergic children treated with oral immunotherapy. Pediatr Allergy Immunol, 2012; 23(2): p. 128-32.
- Bahbah WA, ElHodhod M, Salah M, AlRefaee F, AlTuraiki M, Mousa S, Al Mehaidib A, Ayesh WH, El-Bazzar AN, El Haddad J, El Khashab HY, El Zawahry A, Hasosah M, Shaaban SY, Vandenplas Y. A Survey to Identify the Current Management of Cow's Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region. Nutrients. 2022 Mar 3;14(5):1067.