What is it about ?
In cow’s milk allergy, the body mistakenly defends itself against proteins in cow’s milk. Cow’s milk products then cause allergic inflammation of the skin, intestines and sometimes also of the respiratory tract. The risk of food allergy is higher in families with allergic disorders such as eczema, asthma and hay fever.
Lactose intolerance is not an allergy to cow’s milk and usually does not occur until the child is of school age.
Where and how often?
About 2 to 3 in 100 children develop allergic symptoms after drinking cow’s milk or after consuming products made from cow’s milk. Usually, symptoms appear after a few weeks of regular consumption. Cow’s milk allergy usually occurs in infants and toddlers, and can also appear when the baby is exclusively breastfed (the mother’s feeding is the cause). This allergy disappears at an older age in most children: 6 in 10 children recover from cow’s milk allergy before the age of 2 and 3 in 4 children get rid of it by the age of 3.
How to recognize it?
Some symptoms may occur immediately (i.e. within minutes or hours of ingestion): red skin, itchy skin lesions (hives), or difficulty breathing. General symptoms of a severe allergic reaction (anaphylaxis) are rare. Other symptoms do not appear until several hours, or even several days after consumption: increase in atopic eczema, diarrhea, feeling of malaise, restlessness, stomach aches, etc.
How is the diagnosis made?
The doctor will ask you questions about the symptoms you have seen in the child and examine it to rule out other disorders, such as lactose intolerance or infection.
The doctor will suggest that you keep a symptom diary. This will allow him to better identify the products causing the symptoms. Removing these products from a child’s diet usually decreases symptoms. Conversely, symptoms reappear upon further exposure to products containing cow’s milk protein (the same symptoms and characteristics you wrote down in the symptom diary).
Laboratory tests are not very useful for making the correct diagnosis: allergy skin tests (prick tests) and certain blood tests such as RASTs are not optimal for detecting cow’s milk allergy in young children; patch tests cannot be used for diagnosis either.
Sometimes a provocation test is performed. In this context, the child is voluntarily exposed to the presumed “cause” of the problem. It is imperative that this be done under the supervision of a physician. In the event of a serious allergic reaction (anaphylaxis), it is indeed necessary to act quickly! Based on symptom diary data, start with a small dose of the cow’s milk product and increase the dose to the normal amount for a child of that age (unless symptoms appear).
What can you do ?
It can be very informative for a period of time to keep a food diary and write down the symptoms you see.
What can your doctor do?
Diagnosis and initiation of treatment are often taken over by the pediatrician; symptom monitoring is in principle the responsibility of the general practitioner (except in the event of severe symptoms).
The doctor will give you the necessary advice. It is important that the cause, namely cow’s milk protein, is excluded from the diet. Sometimes symptoms do not appear until after ingestion of large amounts, in which case outright removal of the product is not necessary. This decision must be made on a case-by-case basis.
It may be useful to seek the advice of a dietitian or a nutritionist in order to develop a new balanced diet for the child. The doctor can help you with this.
If the child is bottle-fed, there are special milks on the market: soy ‘milk’, whey, casein hydrolyzate, amino acid preparations. Before the age of 6 months, the first choice is whey or casein hydrolyzate (more degraded products). From 6 months, it is better to use a hydrolyzate or soy milk. Amino acid preparations are synthetic products, which can be used when other products are of no help. Scientific studies show that less than 2% of babies allergic to cow’s milk require a preparation based on amino acids.
Children who are allergic to cow’s milk must consume sufficient amounts of calories, protein, vitamins and minerals. From the age of 2 (sometimes even earlier), they will preferably receive calcium supplements or drinks fortified with calcium if their calcium intake from other products is not sufficient.
A study suggests that certain probiotics have a place in the treatment of food allergies: Lactobacillus rhamnosus GG (LGG) accelerates healing of eczema due to food allergy. In case of cow’s milk allergy, consideration may be given to administering LGG as a short-term treatment (1 month).
During the follow-up, the doctor will check if the child is growing normally and is eating a balanced diet. A diet without cow’s milk protein (avoidance diet) does not necessarily have to be followed for life. Once the symptoms are under control with an avoidance diet, it will be checked after a certain time whether the symptoms reappear after ingestion again. This “re-exposure” will preferably be done in consultation with the doctor, but it can in principle be attempted at home.
Want to know more?
- Milk: for or against? – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Bottles: milk, nothing but milk – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Allergological assessment (patch tests or prick tests), here, Where to find on this page of Cliniques St Luc UCL
Are you looking for more specialized help?
- Find a registered dietitian – Professional Union of French-speaking dieticians
- Find a nutritionist doctor – Belgian Society of Nutritionist Doctors