Allergy to cow's milk

Cow's milk allergy (CMA) is an immune response to the proteins in milk (casein and whey). It differs substantially from lactose intolerance, which is a problem with the digestion of milk sugar (lactose) rather than an immune reaction. ABCD affects about 7% from infants under one year of age, making it one of the most common food allergies in infancy.

Types of ABKM

Depending on the response of the immune system, there are two main types:

1. IgE-mediated (immediate): Symptoms appear quickly - from minutes to 2 hours after consumption. It is caused by an antibody called immunoglobulin E.
2. Non-IgE mediated (delayed): The most common type. Symptoms appear more slowly (2 to 72 hours later) as other parts of the immune system are activated.

Symptoms

Signs usually appear in the first weeks or months of life. Allergic symptoms can affect different body systems:

• Leather: Hives (urticaria), eczema, redness or itching.
• Digestion: Vomiting, diarrhea, abdominal pain and discomfort.
• Airway: Sneezing, runny nose, cough or wheezing.
• Common signs: Irritability, crying (colic) and refusal to eat.
• Emergencies: In rare cases, it may occur anaphylaxis - severe reaction requiring immediate emergency care.

Care must be taken in making a diagnosis, as the manifestations of delayed allergic reaction often coincide with common baby problems. Conditions such as diarrhoea, severe colic, reflux or skin irritations (eczema) occur in many babies and are not always a sign of a milk allergy. Allergy is only one of the possible factors to be considered.

Diagnostics

If you suspect a cow's milk protein allergy, consult your GP or paediatrician. 

• For immediate reactions:  Your child's GP will need to refer you to an allergist who can do skin-allergy samples or blood tests.
• For delayed reactions: Tests are often not useful. The diagnosis is confirmed by elimination diet (off dairy for a few weeks) to see if the symptoms go away.

Your dietitian will be able to help you in choosing which foods should be excluded from your child's diet, or from yours if you are still breastfeeding. 

Nutrition and alternative milks

It is important to know that milk from goats and sheep not a suitable alternative as their proteins are very similar to those of cow's milk.

• Breastfeeding: Breast milk is the best food. If the baby responds to protein through breast milk, the mother may be advised to follow a dairy-free diet.
• Hypoallergenic formulas: For babies on adapted milk, special milks are prescribed:
• Extensively hydrolyzed formulas: Proteins are broken down into small particles.
• Amino acid formulas: In cases where the symptoms do not subside even after the use of extensive hydrolysed milk, a switch to amino acid formula. These formulas are not based on cow's milk and the proteins are completely degraded. Your doctor or nutritionist will help you choose a formula
• Transition to new milk: As these milks taste different, it may be necessary to gradually introduce or add a non-alcoholic vanilla essence (after consultation). The greenish colour of the stools in these milks is normal.

How to deal with this condition?

Your GP is responsible for the diagnosis and long-term follow-up of your child. If confirmed mild to moderate form of delayed allergy, it is advisable to work together with your clinical nutritionist.

However, if there is any doubt about severe form or for immediate reaction (IgE-mediated), the doctor will need to refer you to a specialized pediatric allergy clinic. The GP/paediatrician should immediately prescribe an appropriate hypoallergenic milk and give you instructions on how to avoid cow's milk (including in weaning/feeding formula). 

Nutrition recommendations

• With exclusive breastfeeding: Mothers are encouraged to continue breastfeeding, but should completely exclude dairy products from their own menu.
• Forecast: The good news is that most children outgrow allergies in early childhood. Until then, a team of specialists will make sure the child develops healthily despite dietary restrictions.

Reintroduction of milk: the „milk ladder“

When the time is right, the doctor will discuss with you the careful reintroduction of milk proteins into the diet. This process often follows the so-called. „Milk ladder“ - phased method of feeding:

1. Roast Milk (First Step): It starts with products containing milk baked at high temperature (for example, biscuits). High heat treatment changes the structure of the protein, making it less likely to cause a reaction.
2. Cooked milk (Intermediate steps): Switch to foods in which the milk is cooked for a shorter time.
3. Raw milk (Last step): The last step is the introduction of uncooked fresh milk.

Never start the „Dairy Ladder“ on your own at home without the explicit approval and plan from your doctor or nutritionist.

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