Cow's Milk Allergy (Intolerance) and Its Management

Cow's Milk Allergy (Intolerance) and Its Management

This syndrome is caused by cow's milk protein and needs to be distinguished from lactose intolerance, lactose also being present in cow's milk. The incidence shows striking inter-racial variation. The onset occurs by 6 months and spontaneous remission can be expected by 18 months. There is no test to distinguish it from other enteropathies.


A milk allergy occurs when the child's immune system mistakenly sees the milk protein as dangerous and tries to fight it off. This starts an allergic reaction, which can cause an infant to be fussy and irritable, and cause an upset stomach and other symptoms. Most children who are allergic to cow's milk also react to goat's milk and sheep's milk, and some of them are also allergic to the protein in soy milk.

Regular milk is made up of protein, carbohydrates or sugar, fat, vitamins and minerals, and water. It's the milk protein that causes the allergic reaction in cow's milk allergy. Cow's milk protein allergy can develop in both breastfed and formula-fed children. However, breastfed children are usually less likely to develop food allergies of any sort.

Clinical Features

One of the commonest presentations is with diarrhea and vomiting. Failure to thrive is common, with signs of atopy such as eczema, generalized rash or urticaria. Abdominal distension is usually absent. There may be evidence of iron deficiency anemia with a positive stool occult blood test, or a protein losing enteropathy.

With a true milk allergy, it is usually the protein in milk that you are allergic to, including casein and whey. Symptoms can include vomiting, bloody diarrhea, fussiness, hives, wheezing, and/or trouble breathing, and usually occur no matter what kind of dairy product that they eat. In cases like this, symptoms can occur when a baby drinks a cow's milk based formula or a breastfeeding mother eats or drinks dairy products herself.

On the other hand, children with a lactose intolerance can often handle some types of dairy products, but symptoms are usually limited to diarrhea, gas, bloating, and stomach pains.

Although milk allergy occurs most often in infants and children, it can appear at any age and can be caused by foods that had been previously eaten without any problems. Milk allergy can develop in both formula-fed and breastfed infants.BREAST milk is best, but sometimes, breast-feeding isn't the most convenient option.

Some women find it difficult to breast-feed their babies because they return to work after confinement, or they are unable to produce an adequate amount of milk. Breastfed infants can develop milk allergy to cow’s milk protein passed through breast milk, and may not have a reaction until they drink or eat cow’s milk. Many infants who have milk allergy can lose their allergy by 5 years of age.

Diagnostic Criteria:

  1. Symptoms subside after elimination of cow's milk
  2. Symptoms may recur within 48 hours after a cow's milk challenge
  3. Reactions to three such challenges must be positive and be identical with respect to delay before onset, and duration.

Patients with allergic reactions caused by cow's milk allergy can be divided into 3 groups:

Group 1:
Quick onset reactors (immediate) develop symptoms within minutes or up to one hour after ingestion of small volumes of cow's milk.

Group 2:
Slow onset reactors (intermediate) usually develop vomiting or diarrhoea several hours after ingestion of moderate amounts of cow's milk.

Group 3:
Late reactors develop eczema, vomiting, diarrhoea or asthmatic symptoms after approximately 24 hours, or up to several days after ingestion of normal volumes of cow's milk.

The milk challenge test involves keeping the child off milk for a few days. Cow's milk should be given to the child in a dose of 5 ml/kg. Alter 2 hours give a further 10 ml/kg. If allergy is present the following will occur:

  1. Rise in the eosinphil count to above 450/cmm.
  2. An episode of diarrhea
  3. Occult blood in stool
  4. Significant stool reducing substance
  5. Vomiting
  6. Weight loss more than 300 g in 36 hours
  7. Rise in temperature to 38-40 degrees
  8. Rash or anaphylactic reaction

Management and awareness:

Cow's milk must be replaced by commercially available feeds such as soya formula. Reactions may occur to goat's milk. Both solid and liquid feeds must be free of cow's milk protein. Disaccharide intolerance may accompany the protein intolerance. The need for dietary manipulation usually disappears by 2 years of age.Some awareness might be noted below :

  1. Milk allergy can be diagnosed by positive skin allergy tests
  2. Lactose intolerance is the main problem with milk and can be easily solved.
  3. Infants outgrow their milk allergy; it is not common in older children and adults

Infant milk allergy is thought to be a specific and limited condition which children "outgrow." This idea can be misleading many children continue to have chronic symptoms from milk, although the original problem may disappear, the pattern of illness changes and confuses parents and physicians. At the very least, we can say that some children have an allergic diathesis that persists and evolves with different manifestations. Milk allergy is common in adults but is seldom diagnosed

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