Cow's Milk Allergy

What is a milk allergy?

A milk allergy is a reaction by your child's immune system to the protein in milk. Our immune systems
normally respond to bacteria or viruses that attack the body. With a food allergy, the body's immune
system attacks harmless things, such as the proteins found in cow's milk. Casein is the main protein found
in milk. It is found in the solid part of milk (curd) when milk goes sour. Whey, the liquid that remains once
the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in curd,
whey, or both.
In very young children, cow's milk is the leading cause of allergic reactions. Milk is one of the 8 foods that
are responsible for most food allergies in children. The other foods include eggs, soy, peanuts, tree nuts
(such as walnuts and cashews), wheat, fish, and shellfish. Most kids outgrow milk allergy by 2 or 3 years
of age.
If you think your child is allergic to milk, dairy products or any other food, it is important to get a
diagnosis from your healthcare provider or allergist.

What are the symptoms of an allergic reaction to milk?

Milk allergies are typically discovered very early in formula and breast-fed infants. If a mother drinks
cow's milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend
on whether the child has a slow-onset or a rapid-onset reaction to milk. The slower reaction is more
common and symptoms develop over time.
Symptoms that occur rapidly (within seconds to hours) may include:
• Wheezing
• Vomiting
• Skin reaction (hives).
Symptoms that occur slowly (several hours and sometimes days):
• Loose stools (sometimes containing streaks of blood and/or mucus)
• Diarrhea, abdominal cramping
• Intermittent cough, wheezing, runny nose, or sinus infection
• Skin rash
• Slowed gain in weight and/or height (failure to thrive).
A milk allergy is not the same as lactose intolerance. Lactose intolerance affects only the digestive tract. It
causes symptoms such as bloating, gas and diarrhea.
Although rare, it is possible to have an allergic reaction called anaphylactic shock. This is a serious
reaction that is sudden, severe, and can involve the whole body. It can cause swelling of the mouth and
throat, dangerously lower blood pressure, and trouble breathing. This type of reaction is a medical
emergency. It is treated with epinephrine (a medicine that is given by injection). Usually parents or
caregivers of children who have severe allergic reactions carry their own shot kits, just in case of
emergency.

What formulas are best for my baby?

Pediatricians typically recommend soy-based formulas. These formulas contain soybean proteins, and most
are supplemented with vitamins and minerals making them nutritionally equal to milk-based formulas. The
switch to soy formula helps for about half of babies allergic to milk. If the switch to soy doesn't help with
your child's symptoms, the next step is to give your child a "hypoallergenic" formula. There are two types
of hypoallergenic formulas:
• Extensively hydrolyzed formulas: The proteins in these formulas have been broken down so that they
are more easily digested and less likely to cause a reaction. Brands include Nutramigen, Pregestimil, and
Alimentum. Partially hydrolyzed formulas are not a good substitute.
• Elemental formulas: The proteins in these formulas are in the simplest form and are used when
hydrolyzed formula continues to cause symptoms. Elemental formulas include Neocate and Elecare.

Can I still breast-feed?

Breast-feeding a baby with a milk allergy is sometimes recommended. As a mother, avoiding milk
products in your diet may have a protective effect against allergy. If you decide to avoid cow's milk, you
should take calcium plus vitamin D supplements. Talk with your healthcare provider about whether or not
you should breast-feed.

How can I keep my child safe at school?

• Teach your child not to eat foods unless they are safe. Even young children can grasp this concept,
especially once they have gotten sick after eating a particular food.
• Prepare your child's lunch at home.
• Talk with teachers and the school administrator regarding your child's needs. Ask teachers to keep an
eye out and explain the situation to other children if needed.
• Have the teacher call you if there is a special event or party planned so that you can bring a few
modified treats that your child enjoys and can share with other kids.
• Make a card that lists foods and ingredients that should be avoided and give one to the teacher. The card
can also be helpful to older children in making decisions when out with friends.