Cow milk protein allergy (CMPA) is the most common food allergy in infants and young children, between 2% and 5% of all children suffer from this condition. It is an exaggerated reaction of the immune system to one or more proteins contained in cow’s milk. The protein in cow’s milk is usually one of the first complementary foods introduced into the infant’s diet and is usually consumed throughout childhood as part of a balanced diet. It is very unusual that babies fed exclusively with breast milk can suffer reactions to the proteins of cow’s milk.
More information about Cow Milk Protein Allergy
These proteins can be transmitted through breast milk if the mother has consumed dairy products. In this situation, the clinical guidelines recommend that breastfeeding be continued due to its beneficial effects and that the mother try to eliminate the protein in cow’s milk from her diet. The APLV affects especially children under 2 to 3 years.
Symptoms caused by APLV are diverse and can affect several organic systems, such as the skin, digestive or respiratory system, which can lead to rashes, eczema, vomiting, diarrhea, cramps, wheezing or excessive crying . Allergic reactions can begin very quickly, such as with severe respiratory problems and vomiting; however, a larger amount of food, such as a glass of milk, may also be delayed or required.
An example of a delayed reaction would be a rash or diarrhea, which may take up to 3 or 5 days to appear. In formula-fed infants and older children, it will be necessary to avoid cow’s milk proteins to eliminate the symptoms of CMPA. This requires that adequate substitute foods be established with the advice of a medical professional.
As we have already mentioned, in case your child takes breast milk, it is recommended that the mother change her diet and exclude all milk proteins from her diet. If that does not help, the pediatrician will advise you to take an adapted infant formula that may contain hydrolysed proteins or a formula that does not contain cow’s milk proteins, such as the so-called formulas with amino acids or elementals.
Allergy to cow’s milk (APLV) in infants and children
Research in this field has not yet been able to find the reasons why food allergies occur, cow’s milk being the most common food allergy in infants and children. Symptoms can be avoided by removing the protein from cow’s milk from your child’s diet.
Cow’s milk allergy is very rare in children fed exclusively on breast milk and is usually mild. In this situation, the clinical guidelines recommend that breastfeeding be continued due to its beneficial effects and that the mother try to eliminate the proteins of cow’s milk from her diet.
APLV or lactose intolerance?
Despite sharing some of the symptoms, APLV and lactose intolerance are two totally different conditions that affect the body differently. It is very easy to confuse them, however, the following information will help you differentiate them.
The main difference is that APLV is a food allergy, which means that the immune system overreacts to one or more proteins present in cow’s milk. To avoid an allergic reaction to food, it is important to avoid the intake of protein.
Lactose intolerance is the inability to digest milk sugar (called lactose). It is a food intolerance, which means that the body can not digerireste nutrient. The immune system is not involved so there is no allergic reaction. Symptoms such as bloating, abdominal pain, flatulence or diarrhea may be signs of lactose intolerance. Neither the skin nor the respiratory system are affected.
Again, the symptoms of lactose intolerance can only be controlled by avoiding all foods that contain lactose, such as all types of milk and milk products. Fortunately, dairy products and milk without lactose are available in most stores and can be a good alternative.
Check with your pediatrician if you are worried or if you are unsure about your child’s symptoms.
Skin puncture tests (SPT or PST)
Skin prick tests are very accurate in the diagnosis of cow’s milk allergy. Small drops of cow’s milk or other possible food causing the allergy on the child’s forearm are placed. A small puncture is made in each drop on the skin. If the child’s skin becomes red and itchy, it usually means that he is allergic to that particular allergen. This is known as a positive reaction. If you do not show any reaction in the test, there is still the possibility that your child has a food allergy. This may occur if your child shows late reactions after food intake, which is called a non-IgE-mediated reaction.
Skin prick tests are pretty fast. Therefore, they are often used as first tests to evaluate which foods cause the production of antibodies. Once the allergens are identified, the doctor can perform more specific tests (for example: RAST).
Epicutaneous test (APT)
With an epicutaneous test (APT) can analyze the symptoms of late onset and, specifically, atopic dermatitis and late abdominal symptoms. APT has the advantage of being able to demonstrate APLV, even when puncture tests and blood tests are negative. The allergenic food extract is applied to a pad that sticks to the skin of the child’s back and stays in place for 24 to 72 hours. ATP diagnoses the reaction of so-called T lymphocytes (part of white blood cells that have important immune function).
Specific IgE tests (formerly known as RAST test)
Specific IgE tests are blood tests that can measure the concentration of specific antibodies in the child’s blood. These antibodies are called IgE. IgE levels in the blood are usually higher in children with allergies or asthma. If the RAST is negative, it is still possible for your child to have a food allergy; however, in this case it is a delayed or non-IgE-mediated reaction.
Your child’s doctor may recommend an elimination diet to prove that your child reacts to foods such as cow’s milk, eggs, wheat, or soy. With the results of this elimination diet, your child’s medical history and blood tests, as well as the diary of food and symptoms, your doctor will have something to work with when trying to come up with a diagnosis.
The organization of a diet of these characteristics requires the strict supervision of the nutritionist or doctor of your child. The food suspected of causing the problem will be eliminated from your baby’s diet for one or two weeks. It is important that you avoid foods that contain the element that could trigger the symptoms. The doctor or nutritionist will give you precise instructions on how to do it and is likely to prescribe a formula with amino acids without cow’s milk protein to feed your baby properly during an elimination diet.
Exposure to food
Your pediatrician may want to start a food exposure if you think your child may have overcome his food allergy. Before starting, your child’s symptoms should have disappeared or at least stabilized. What can wait? In an exposure test, very small amounts of an allergen are taken orally. These can be found in various infant formulas such as fruit juices, purées or cereal porridge depending on the age of the child.
Exposure to food can be open (both your doctor and you know what your child will be provided), simple blind (your doctor knows but you do not) or double blind placebo controlled, which means that Neither the doctor nor you know if the child is given the allergen formula or the placebo. The type of food exposure performed with your child will depend on the practice and methodology that is usually applied in your pediatrician’s clinic.
Caution! Exposure tests should be supervised by a healthcare professional and carried out best in a clinic or hospital with equipment and qualified personnel.
How can APLV be diagnosed?
What happens in the doctor’s office:
To diagnose CMA, your pediatrician will need more than just a simple test. When deciding whether your child has a food allergy, the child’s symptoms, medical history and evaluation, as well as the results of the tests, will be taken into account.
What is the best way to prepare for the consultation:
When it comes to diagnosing allergies, the child’s medical history can be as important as the results of diagnostic tests. Before visiting the doctor, you should prepare information about your family’s medical history, as well as your child’s medical history.
Identifying the symptoms of APLV is the first step in alleviating your baby. Therefore, it will also be very useful to keep a detailed list and a diary of the symptoms. Access the symptom diary and access the list of symptoms.
In addition, it is a good idea to prepare the questions you want to ask the doctor, such as:
- Could my child’s symptoms be due to a food allergy?
- Is it possible to confirm my child’s food allergy?
- What tests have to be done?
- Do I need to go to a specialist?
- What will be the next steps?
Diagnostic tests that the doctor might want to perform:
Your child’s doctor must use all of the above information to decide which allergy tests are necessary. Allergy tests can include blood tests and skin tests, as well as diagnostic diets. The type of test that the doctor considers appropriate will depend on the type of allergy that is suspected.
Skin tests are given preference because they are faster. When allergic reactions occur immediately after the child has eaten, a skin test or blood test is more likely to be positive, while symptoms that appear after a while are more difficult to test in the blood . Keep in mind that this type of allergy tests are only part of the diagnostic process since positive or negative erroneous results can occur. This means that your child may show allergy symptoms even though the test says he is not allergic.
Diagnostic diets, such as diets for elimination or exposure to food, can be chosen when allergic reactions occur hours or days after ingesting the food.
All these tests must be done under medical supervision by a specialist.
With information about your child’s medical history, symptoms and allergy tests, you and your child’s doctor will be able to develop a plan to control the symptoms.
Symptoms of the APLV: nutritional control
The symptoms of APLV can be controlled from a nutritional point of view by removing the proteins of cow’s milk from your child’s diet. There are many substitute options available, such as formulas that contain hydrolyzed proteins or formulas that do not contain cow’s milk proteins, which are the so-called formulas with amino acids or elementals.
As your child needs protein for growth and development, you can not limit yourself to completely removing proteins from your child’s diet. Instead, you should make sure that the milk proteins are replaced by equivalent nutritional alternatives.
Your doctor may consider extensively hydrolyzed formulas and formulas with validated amino acids as a good option to control the necessary replacement of cow’s milk proteins. These products are considered hypoallergenic and provide a balanced diet for children with CMA and other allergy-induced disorders. They guarantee that your child receives all the nutrients he needs for healthy growth and development when the recommended amount of the formula is consumed. The extensively hydrolyzed formulas still contain very small protein fragments, while the formulas with amino acids do not contain milk proteins.
APLV and lactation
If your baby shows signs of APLV while breast-feeding, tell your doctor. If it is confirmed that you have APLV, it is not an allergic reaction to the breast milk itself. In fact, breastfeeding can protect your child from the onset of certain diseases. Rarely, babies fed only breast milk can react to the proteins in cow’s milk. These proteins can be transmitted through breast milk if the mother has consumed dairy products.
As a first step, try to eliminate cow’s milk and milk products from your diet while you continue breastfeeding. If you avoid cow’s milk completely, the symptoms should disappear soon. Since cow’s milk is part of many foods, you will have to look at the ingredients of your daily diet. Consult a nutritionist before beginning the elimination diet.
If the baby’s symptoms do not disappear or it is very difficult to continue with that diet, the nutritionist can suggest a hypoallergenic diet with substitute formulas for your baby. The substitute formula can be a widely hydrolyzed formula or a formula with amino acids.
Both formulas will provide a complete source of nutrition for your baby; however, they differ in whether they are based on completely predigested cow’s milk proteins or non-allergenic amino acids. Ask your pediatrician or specialist about the best formula for your child.