Cow’s Milk Allergy (CMA) is an immune reaction to one or more of the proteins found in cow’s milk and affect around 5% of infants in their first year. CMA is more common in families with atopic conditions such as asthma, eczema or hayfever and can affect the skin, gut and in more severe cases the respiratory system. Reactions may be immediate (IgE) or delayed (non-IgE); delayed reactions being more difficult to spot with symptoms similar to other conditions in infancy such as reflux, colic, constipation and diarrhoea.
Cow’s Milk Allergy in Infancy
CMA occurs in breast-fed and formula-fed babies. Both immediate (IgE) and delayed (non-IgE) reactions can vary, from mild-moderate to severe and persisting symptoms, with some infants not gaining enough weight and becoming very difficult to feed. Most infants present within the first 6 months and in particular.
• when weaning to solids (increased exposure to milk proteins from the diet)
• when changing from breast-feeds to cow’s milk formula (or when adding in a top-
• when following a gastrointestinal infection (which may be lactose intolerance
rather than CMA)
Typical symptoms of CMA
• reflux or vomiting
• unsettled, crying, difficult to feed
• painful wind
• loose and/or bloody stools
When to see your paediatric Dietitian
See your Paediatric Dietitian if your baby has more than one of the above symptoms and is affecting feeding, sleeping or gaining weight. Your Paediatric Dietitian will help identify the type of symptoms, confirm a diagnosis, and advise on immediate and longer-term dietary treatment including weaning and when to reintroduce milk again. In instances when symptoms are unresolved by dietary treatment or when tests/investigations are indicated, your paediatrician can help.
Examination and treatment
No single diagnostic test is available to confirm CMA and for infants with severe immediate reactions (IgE), an allergy specialist Paediatrician is recommended.
Identifying the symptoms, confirming a diagnosis and getting the right treatment formula or breast-feeding advice, starts with an allergy focused clinical history. Care and attention is needed to assess the dietary intake, ensuring the right balance of nutrients for both mum and infant. Dietary treatment is started immediately and advice given on conducting a diagnostic challenge. Your Paediatric Dietitian will advise if allergy tests will be helpful or not and recommend the most suitable prescription formula to try if required.
The symptoms of Cow’s Milk Allergy are resolved by the complete avoidance of cow’s milk and its products such as cheese, yoghurt, butter and cream from the diet. Tolerance to cow’s milk is achieved for most infants within a year, and for those who experience severe and persisting symptoms, this usually happens later in childhood.