Cow’s milk allergy is the most common food allergy. It affects 1 in 50 children and usually begins in the first 3 months of life.
80% of children who react to fresh milk tolerate baked milk in biscuits and cakes. In this case, your child should continue to eat the baked milk products to maintain and improve their tolerance.
Immediate reactions. Fifty percent of infants have symptoms that begin straight away. These include hives / “nettle” rash and swelling of the lips. Some children feel sick, vomit or have diarrhoea. Severe reactions (anaphylaxis) are much less common, but include difficulty breathing (wheeze or throat swelling), feeling faint or dizzy.
Delayed reactions These occur hours or up to a day or two after eating the food. They include flares of eczema, vomiting after feeds, colic and diarrhoea (sometimes with blood in the stools).
This is not an allergy but an inability of the gut to breakdown milk sugar (lactose). It causes watery diarrhoea, flatulence and / or stomach cramps. This usually follows a bout of gastroenteritis and gets better a few weeks after the tummy upset resolves.
Children with cow’s milk allergy are usually allergic to goat’s and sheep’s milk. A smaller number of children will also have a soya milk allergy. It is uncommon for a baby with a cow’s milk allergy to react to breast milk. Mother should not exclude cow’s milk and dairy from their diet without prior professional advice.
Alternative low allergy milk formulas include SMA Althéra, Aptamil Pepti 1 or 2, Nutramigen LLG and Similac Alimentum. A few babies will also have symptoms on these formulas and need more specialised amino acid formulas. Soya protein-based formulas can be considered in infants over 6 months old.
The diagnosis is usually based on a history of a typical reaction. If the reaction is immediate skin prick tests or specific IgE blood tests can be helpful. Allergy tests are not helpful in the diagnosis of delayed allergic reactions, such as in flares of eczema.
Children who are allergic to cow’s milk should avoid full fat, semi-skimmed, skimmed, sterilised, evaporated and condensed cow’s milk. Other products to avoid include:
milk powder milk solids non-fat milk solids butter / buttermilk
cheese cream ice cream yogurt
fromage frais crème fraiche casein/caseinates margarine
ghee whey/whey hydrolysate
Cooking and heating make milk proteins less allergic. 80% of children reacting to fresh milk will tolerate baked milk in biscuits and cakes. If so, the child should continue to consume these baked milk foods.
Because of potential nutritional deficiencies, particularly in young infants, advice from a paediatric dietitian is recommended. Your dietitian can advise on alternative milk formulas, and sources of vitamins and calcium for you and your baby. They can also provide advice on increasing the amount of baked or processed milk products (milk ladder). This will help your child outgrow their milk allergy more quickly.
A written management plan will be given in clinic. Allergy medication should be available at all times.
If a child gets hives or swelling, tell them to spit the food out, and then give them an antihistamine.
- Difficulty breathing (wheezing, noisy breathing, blue colour)
- Swelling in the throat (noisy breathing, drooling) and tongue
- Feeling faint or dizzy, looking very pale (lie the child down with their legs raised).
If any of these severe symptoms occur get help straight away and dial 999 stating “anaphylaxis” (ana-fil-ak-sis).
Delayed reactions may be troublesome, but rarely cause life-threatening symptoms and the mainstay of treatment is avoidance.
Inform the nursery/school and after-school clubs. Grandparents, relatives and school friends’ parents will also need to know. We suggest sharing the child’s allergy plan with them.
Four out of five children will outgrow their milk allergy by school age. Children should be reviewed every 6 months to see if they still need to avoid dairy. Your allergy team can provide advice on how to increase the amount of baked or processed milk products (milk ladder). This will help your child outgrow their milk allergy more quickly. Click on the icon to review our guidelines for Home milk challenge.