Cow’s milk protein allergy is the most common food allergy in infants and young children with approximately 3 – 8 % of children under 3 years of age being affected. Typically, milk allergy presents within the first year of life, with most children eventually building up a tolerance and outgrowing their allergy. Cow’s milk allergy is often confused with lactose intolerance. It is important to know the difference as lactose free formulas and products available in supermarkets and health food stores will still not be suitable for cow’s milk allergy sufferers.
A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is eaten, it can trigger an allergic reaction that may include a range of symptoms from milder symptoms (rashes, hives, itching, swelling, abdominal pain, vomiting and/or diarrhoea) to more severe symptoms (breathing difficulties, wheezing, loss of consciousness – otherwise known as anaphylaxis). Anaphylactic reactions can be potentially fatal.
Unlike food allergies, food intolerances do not involve the immune system. People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products. As a result, lactose-intolerant patients are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating and diarrhoea. While lactose intolerance can cause great discomfort, it is not life-threatening.
Obtaining the right diagnosis
It is important that food allergies are diagnosed by a healthcare professional with the right training. They will ask questions about the symptoms and may perform tests. The type of tests will depend on the type of reactions the patient has.
For immediate reactions
Skin prick tests or blood tests that measure ‘specific IgE antibodies’ may be used to help with the diagnosis. These results can be difficult to interpret without an allergy specialist.
For delayed reactions
At present, the most reliable method for diagnosing delayed reactions is a food exclusion and reintroduction diet. This involves the removal of the suspected food(s) from the diet for a set period of time. The food is slowly re-introduced to see if it causes a reaction.
Some companies offer food allergy or intolerance tests that measure ‘IgG antibodies’, but these are not a reliable way of diagnosing cow’s milk allergy or intolerance. Other tests such as hair analysis, kinesiology testing and Vega testing have also been found to be unreliable.
Formula for infants with cow’s milk allergy
It is recommended that formula-fed infants who are allergic to cow’s milk protein use an extensively hydrolysed formula. This type of formula contains protein that has been broken down so it is less allergenic than milk protein. Examples of hydrolysed formulas are Similac Alimentum®, Nutricia Pepticate® or Nestle Alfare®. Soya formulas are not recommended in the first 6 months of life due to high phyto-oestrogen levels and potential overlapping sensitivity in cow’s milk allergic individuals. In more severely allergic cases, an amino acid based formula, such as Neocate®, may be required. Before trying a milk substitute please liaise with your paediatrician and paediatric dietitian to ensure you are using the correct formula based on your child’s needs, age and severity of symptoms. A milk free formula is an excellent source of essential nutrients, therefore children on restricted exclusion diets can continue to use it well past the first year of life. Older children can use calcium enriched milk substitutes such as soya or oat milk.
South African food labelling laws (DoH R146) currently require that labels must clearly state whether cow’s milk is an ingredient in a food product. These laws apply only to packaged, manufactured foods and drinks sold in SA. Read all product labels carefully before purchasing and consuming any item. Ingredients in packaged food products may change without warning therefore check the ingredient lists every time you shop.
Avoid foods that contain milk or any of these ingredients:
- Butter, butter fat, butter oil, butter acid, butter ester(s)
- Casein and caseinates (in all forms)
- Cottage cheese
- Lactalbumin, lactalbumin phosphate
- Milk (in all forms, including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low fat, malted, milkfat, fat free, powder, protein, skimmed, solids, whole)
- Milk protein hydrolysate
- Rennet casein
- Sour cream, sour cream solids
- Sour milk solids
- Whey (in all forms)
- Whey protein hydrolysate
- Milk is sometimes found in the following:
- Artificial butter flavour
- Baked goods
- Lactic acid starter culture and other bacterial cultures
- Luncheon meat, hot dogs, sausages may use milk protein as a binder
- Flavouring on crisps, popcorn or nuts
- Cross contamination in deli counters, restaurants and food processing and packaging.
NB: The above information is not intended to replace seeing a healthcare professional trained in allergy management. If you suspect your child may have cow’s milk or other allergies, please consult with your GP and/or Paediatrician and request the input of a paediatric dietitian to ensure your child is not missing out on valuable nutrients such as calcium.