Cow’s Milk Protein Allergy in Babies

Cow’s milk contains 2 types of protein – whey and casein. When a child has a Cow’s Milk Allergy (CMA) it is one or both of these proteins that is the allergen. Casein is found in the solid part (curd) of milk that curdles. Whey is found in the liquid part of milk that remains after milk curdles. Your child may be allergic to only one milk protein or to both. These proteins may be hard to avoid because they’re also in some processed foods. And most people who react to cow’s milk may also react to sheep’s, goat’s and buffalo’s milk. More commonly, people allergic to cow’s milk may also allergic to soya milk.

Cow’s Milk Protein Allergy (CMPA) can be a very complex condition and when we see babies and children who we suspect have a CMPA in our clinic, we always refer them to a Paediatric Dietitian. Cow’s Milk Allergy (CMA) is the most common food allergy seen in infants and children. Between 2 and 7.5% of children are estimated to have CMA. However, the actual numbers could be much higher as there’s a high rate of failure to diagnose the Delayed Onset type of CMA. This is backed up by a 2009 study in the UK where it was demonstrated that, of 1000 children with a diagnosis of CMA, there was considerable under diagnosis, delayed diagnosis and incorrect diagnosis. CMA can present with a spectrum of acute or delayed symptoms that can be mild, moderate or severe in nature – easy to see how it can be misdiagnosed or missed isn’t it!

There are 2 different types of Cows Milk Allergy to look at.

 1. IgE mediated CMA – Acute Onset; This type typically occurs within a few minutes of taking cow’s milk protein and symptoms can range from mild urticaria (rash) to serious anaphylaxis. This is certainly the more serious of the 2 types and is likely to last longer. It’s easier to diagnose as the symptoms relate to the intake of dairy and are obvious. It presents as a very typical allergy that most people will recognise and seek medical attention for.

 2. Non IgE-mediated CMA- Delayed Onset; This type of CMA occurs several hours or days after taking cow’s milk protein and tends to affect the gastro-intestinal tract, the skin and the respiratory system. This is the type of CMA we see most frequently at the clinic. Because of the delayed signs and symptoms, it can be difficult to pinpoint the food causing the allergy in older children and therefore difficult to get a diagnosis. With babies under 6 months old it’s slightly more straight forward as they only drink milk.

There are several circumstances that can help point to a diagnosis of Cows Milk Allergy. Many medical practitioners rely on these associated circumstances to make their diagnosis and therefore it’s important to tell your Doctor if your baby has any of the following.

1. A family history of allergy, most significant in parents and siblings.

2. Symptoms that are persistent and affect different systems – gastrointestinal, skin, respiratory.

3. Babies who have moderate to severe atopic eczema or dermatitis.

4. Babies who have gastro-oesophageal reflux disease (GORD) or any other gastrointestinal symptoms such as “colic”, loose stools, constipation.

General Symptoms of Cows Milk Allergy.

Gastrointestinal Symptoms

1. Vomiting

2. Reflux

3. Colic

4. Diarrhoea

5. Constipation

6. Flatulence

7. Stomach pain

8. Mucousy Stools

9. Distended Stomach

Dermatological Symptoms

1. Eczema

2. Rashes (skin and nappy)

3. Hives (nettle sting type rash)

4. Wheals

5. Contact Dermatitis

6. Swelling of the eyes and lips or the whole face or localised

swellings (angioedema)

Respiratory Symptoms

1. Wheezing

2. Sore Throat

3. Nasal Congestion

4. Persistent Runny Nose &/or Eyes

5. Ear Ache

6. Persistent Cough

7. Oral Irritation (itchy mouth, excessive dribble)

This list highlights the varying symptoms that may be seen in babies and children with a CMA and demonstrates the difficulty often experienced in getting a diagnosis.

How Paediatric Osteopathy helps a baby with a Cow’s Milk Protein Allergy.

When a baby has CMPA their nervous system, in our view, is in “fight or flight” mode. They are in digestive pain, can have reflux, gas, slow bowel clearance and irritation of the skin (eczema). Their body is in distress.

Treatment must focus on calming the nervous system response to distress. Gentle techniques are applied to the cranium to ease muscular tension in the neck. We then work on the respiratory system to ease tension of the ribcage and the breathing diaphragm. This allows decreased traction on the oesophagus as it passes through the breathing diaphragm. This is important for feeding.

We continue with gentle visceral techniques to the abdominal fascia to improve digestive transition in the intestinal tract. Finally, we rebalance the baby’s breathing with their cranial motion to establish nervous system calibration.

Paul’s Story

Mum brought Paul to see us when he was 12-weeks old. He was born at 39 weeks following an 8-hour labour which was uneventful. Mum described Paul as irritable in general with a very poor sleeping pattern. Paul had difficulties feeding and taking all his feeds, burping was tough, and his bowels were very variable as he may not have a poo for 4-5 days.

Mum had changed formula 4 times from the standard formula to a comfort formula to lactose free formula and finally returned to a standard formula again. She said there was very little difference in him when formulas were changed.

Paul had recently developed nasal congestion and was now wheezing. Mum had taken Paul to the doctor to check his chest which was clear. He had also developed a rash on his face, eyebrows and scalp which would ease when a cream was applied but would return after stopping the application of the cream. His skin had a dry appearance and was starting to look redder in recent weeks.

We were particularly interested in Paul’s family history of food allergies, asthma, hay fever and eczema. Mum stated that dad had eczema as a young baby, cried for 9 months and was put on goat’s milk formula. Paul’s brother, who was now 3- years old, had chronic reflux as a baby and developed asthma as a toddler. Mum said they changed formulas for his reflux numerous times but that he just “grew out of it” at 10 months. “He still doesn’t like milk and prefers drinking water” she added.

Our view was that Paul could have a Cow’s Milk Protein Allergy. I treated Paul’s digestive system to give him ease and referred him to a Paediatric Dietician to access if he had CMPA. The dietician switched Paul to a specific formula for CMPA and would review him in a month. We saw Paul at the clinic 5-weeks later. His skin condition had cleared up. He didn’t have a wheeze, he was pooing most days and his Mum reported that he was less irritable and was sleeping much better. Paul was assisted with weaning by the Paediatric Dietitian and was later guided back onto diary using the Milk Ladder under the supervision of the Dietitian.

Cork Children’s Clinic

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