Cow’s Milk Allergy

Cow’s milk allergy | Dairy intolerance

Cow’s milk allergy is the most common food allergy in babies and small children.  It is important to distinguish the “immediate” and “slow onset” reactions to cow’s milk.  The slow onset reaction is called “cow’s milk protein intolerance”.

How common: about 1 in 20 are affected (perhaps even more). However, most grow out of cow’s milk allergy by about two or three years old.

Symptoms (quick onset) ALLERGY – Skin Prick Test may be positive

Colic/ inconsolable crying
Eczema / dermatitis
Urticaria/ hives

Symptoms (slow onset) from an INTOLERANCE – SPT may be negative.

Eczema / dermatitis
Gastric reflux
Abdominal pain
Blood in poop (cow’s milk colitis)
Poor growth
Headache / Irritability

Diagnosis of cow’s milk allergy: The first step is to be suspicious that cow’s milk (and other foods) could be a problem.

A Skin Prick Test (SPT) (or RAST) can help make the diagnosis of the quick onset reaction.

Otherwise it is elimination and challenge (trial and error: taking cow’s milk out of the diet and see if your child improves).

Difference between dairy allergy and lactose intolerance

Cow’s milk/ dairy allergy is an adverse food reaction to milk proteins. But lactose intolerance is not an allergic reaction. Lactose intolerance is the inability to digest the milk-sugar, lactose. The enzyme lactase is needed to digest lactose. Symptoms from lactose intolerance usually follow higher amounts of milk consumption.

Cow’s Milk Colitis

Blood in the poop in a breastfed baby is usually means  “Cow’s Milk Colitis”.  This happens when your baby’s immune system overreacts to the proteins found in cow’s milk, leading to inflammation in the colon.

Babies differ in how sensitive they are to milk. Some have very few symptoms, and others might experience blood in the stools if a breast-feeding mother has even a small splash of milk in her morning coffee.

Cow’s milk Colitis affects about 2% of babies.

Allergic colitis often has few symptoms, but may be associated with irritability, gassiness, and with blood or mucus in the stools can make eating very uncomfortable for a baby, so they may not get the nutrition they need.

What to do: The breast feeding mother needs to go on a dairy-free diet (or the baby is switched to a hypoallergenic formula). It takes up to 72 hours for the mother’s breast milk to become free of milk protein.

Note, that nearly half of babies who are allergic to cow’s milk protein are also allergic to soy protein. So, if your baby’s symptoms don’t clear up, it is recommended that a nursing mother avoid soy as well as dairy (or use a soy-free formula). Have a look at the Special Formula Blog post.

Your baby’s gut will need time to heal. That’s why you may continue to notice blood in the stool for three to four weeks after starting a milk/soy-free diet. But you should notice that your infant seems to be feeling better — less irritable and less reluctant to feed and also may be putting on weight, which is a good sign.

This reaction to dairy/soy usually naturally goes away by about a year of age.