Around 2% of babies have a CMPA (Venter et al, 2017). It is the most common food allergy in babies under 1 years of age. Research hasn't found an exact reason as to how this is developed although the numbers seem to be on the rise.
What is CMPA?
Cow's milk naturally contains a variety of nutrients, one being protein. The proteins found in milk are called casein and whey. When some babies drink or eat cow's milk, a reaction occurs when the body reacts to these proteins triggering an immune response. These reactions can happen immediately after eating any cows milk products or can be delayed.
How common is CMPA
CMPA is very common with the risk being higher in infants. The risk decreases as children get older, occurring in less than 1% of children 6 years and under. If your child is over the age of 6 years and starts to develop symptoms it is likely they have a lactose intolerance.
Are there different types of CMPA?
Yes there are two types of CMPA; IgE mediated (immediate reactions) and non-IgE mediated (delayed reaction). The two types present with different symptoms however your little one could display reactions from both categories.
For more information on the differences between IgE mediated and non-IgE mediated allergies check out my blog on understanding the differences below.
What are the signs and symptoms of CMPA?
Signs and symptoms of CMPA are very diverse. Symptoms usually develop within the first week that cow's milk is in a child's diet.
A child with an immediate reaction may develop symptoms such as;
Vomiting
Difficulty breathing
Mucous or blood in stools
Facial Swelling
Poor growth
Some children may also develop a rash or a runny nose
Most children have a delayed reaction to CMPA and show signs that involve skin or the gastrointestinal system. Gastrointestinal symptoms can include vomiting, abdominal pain, unsettledness, back arching, blood and/or mucus in stools and diarrhoea. Skin symptoms can include hives and eczema.
When should you contact your doctor?
If your child is refusing to feed or eat, has blood/mucus in their stools, vomiting after feeds/food, weight loss or diarrhoea/constipation, you should contact your doctor or health visitor.
How is CMPA diagnosed?
Clinical history and physical examination are the most helpful ways to diagnose CMPA. It may be useful to keep a food and symptom diary. You can find one here that may be useful.
A healthcare professional may suggest an exclusion diet and challenge. This is a 4 week trial of a milk free diet to see if your child's symptoms improve.
If you are breastfeeding and think your little one is reacting to cow's milk through your breastmilk, this would involve you avoiding dairy products in your diet. If your baby is already weaning they will need to follow milk free weaning advise.
Your GP or health visitor should organise a referral to a Paediatric Dietitian as diagnosis can only be confirmed following the reintroduction of the food that had previously produced any symptoms. This process is often referred to as the "milk challenge".
This can be carried out at home for most children and best practice is to do this alongside a Paediatric Dietitian.
I've seen allergy tests I can buy online. Can I use these instead?
There are lots of alternative tests out there marketed to diagnose allergies. Some of these include IgG, iridology, hair analysis, kinesiology or cytotoxic testing. Costs can vary and are available online and both from local practitioners.
However, these types of testing are not scientifically based. There is no evidence for their use and should not be used to diagnose an allergy or a intolerance.
The only evidence based methods for diagnosing allergies are the ones outlined in my previous blog.
My baby reacted during the milk challenge - what happens now?
Once confirmed, you will be advised to follow a dairy free diet. If you have not already been referred to a Peadiatric Dietitian you should be now. This is because dairy products provide valuable nutrients and minerals for your little ones diet and by cutting these out and not appropriately replacing them can potentially effect your child's growth, development and cause nutritional deficiencies.
Always seek the advice of a healthcare professional before you try a diet that avoids a whole food group. If you need any advise please get in touch.
References:
Venter, C. Brown, T. Meyer, R. Walksh, J. Shah, N. Nowak-Wegrzyn, A. Chen, T. Fleischer, D. Heine, R. Levin, M. Vieira, M.Fox, A. (2017). Better recognition, diagnosis and management of non-IgE mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. 23 (1); p 7-26.
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