By Sr Teresa Hayward (RN, RM, Lactation consultant, Infant & Paediatric Nutritionist, Baby Sleep consultant)
I have decided to write this article as I see so many babies being diagnosed as a cow’s milk protein allergy from having one symptom, and it actually isn’t an allergy at all.
There are definitely instances where children and adults can’t tolerate cow’s milk or dairy, and it is usually due to an allergy such as Cow’s milk protein allergy or Lactose intolerance. These are two totally separate diagnoses and are often confused and misdiagnosed.
Cows milk protein intolerance or allergy is defined as an abnormal response by the body’s immune system to the proteins in cow’s milk. It mainly occurs in young babies.
There are 2 different types of CMPI. The one will show symptoms up to 2hrs after consumption of a cow’s milk product, whereas in the other type, symptoms will develop more slowly and occur later. They can occur after a couple of days or even a week after ingesting cow’s milk.
CMPI is actually extremely rare. It actually will only occur in about 2-3% of all formula fed infants, and approximately 0.5% of breastfed infants. This is because formula is cow’s milk based and breastmilk isn’t. Breastfeeding is also seen to be the protective mechanism in preventing cows milk allergy. Risk factors for CMPI include having a parent or sibling with asthma, eczema and seasonal allergies
What are the Symptoms of CMPI?
Infants most commonly will show signs that involve Respiratory, Skin and Gastro-intestinal symptoms
Respiratory
· Nasal congestion
· Coughing
· Wheezing
Skin
· Hives
· Rash
· Eczema
Gastro-intestinal
· Vomiting
· Abdominal cramping
· Mucous in stools
· Diarrhoea
· Bloating and gas
· Blood in stool
Other signs
· Facial swelling
· Irritability
· Poor sleep
· Poor growth due to feeding aversion or poor absorption of nutrients
How is CMPI Diagnosed?
It is usually a clinical diagnosis, meaning it is determined through thorough history taking of feeding patterns, timeline of symptoms, and family history. We also do a thorough physical examination of baby and assess baby’s weight history.
How is CMPI Treated?
The main treatment is the elimination of cow’s milk entirely from the diet. It will take about 1-2weeks for you to see a difference as the gut needs time to heal, so you don’t always see an immediate response.
We place formula fed babies onto an extensively hydrolyzed formula where the proteins are partially broken down so that they can digest more easily. In breastfed babies, we will ask Moms to eliminate Cows milk from their diet.
Approximately 50% of babies will outgrow their allergy and will be able to tolerate cow’s milk at 1year.
What is Lactose Intolerance, and How is It Different than CMPI?
Lactose is the sugar that is found in milk, and it is digested by the enzyme Lactase. Lactose intolerance means the gut is unable to absorb lactose and it is not an immune response. The main type of Lactose intolerance is Primary lactose intolerance, and it is a condition where the small intestine doesn’t produce lactase meaning they cant digest the lactose causing them to be unable to digest milk, but they aren’t actually allergic to it.
It is a harmless condition, buy the symptoms are uncomfortable. There are also a few distinguishing factors between lactose intolerance and CPMI:
· Symptoms in lactose intolerance are localised to the gut – abdominal discomfort, cramps, gas, bloating, nausea, diarrhoa. In CMPI, symptoms will also be present in respiratory and skin systems
· Lactose intolerance usually develops in older children and adults rather than young babies. Babies can however be sensitive to lactose, hence the diagnosis Lactose overload
· Those with lactose intolerance can often tolerate small amounts of dairy, such as yoghurt, whereas CMPI can’t tolerate any dairy
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