BENGALURU: What is Cow’s Milk Protein Intolerance?
Cow’s milk protein intolerance (CMPI) is an abnormal reaction to protein found in cow’s milk. The immune system normally protects our bodies from harm caused by bacteria or viruses. A milk allergy occurs when the immune system mistakenly recognizes the milk protein as something the body should fight off. This starts an allergic reaction, which can cause an infant to be fussy and irritable, and cause an upset stomach and other symptoms
Risk factors for developing CMPI include having a parent or sibling with allergic disease (like asthma, eczema, and seasonal allergies). Infants who are breastfed have a lower risk of developing a milk allergy than those who are formula fed.
What are the Types of CMPI
Cow’s milk protein intolerance can be divided into immediate reaction and delayed reaction. The two types have different symptoms associated with each.
Immediate reaction, symptoms usually start within 2 hours of drinking cow’s milk. In delayed reaction, symptoms happen later, from 48 hours to 1 week after drinking cow’s milk.
What are the signs and symptoms of CMPI?
Signs and symptoms of cow’s milk protein intolerance are very diverse. Symptoms will usually develop within the first week of starting cow’s milk in their diet. Most infants will show signs that involve the skin or tummy. Tummy related symptoms can include vomiting, abdominal pain, blood in the stools, and diarrhea. Skin symptoms include hives and eczema. Babies can also present with breathing difficulty, irritability, facial swelling, and poor growth due to poor absorption of nutrients.
When should you consult a doctor?
Red flags: Increased tiredness or lethargy, fevers, severe vomiting or diarrhea, not tolerating any feedings, weight loss, blood in the stools.
Is lactose intolerance the same as milk allergy?
No. Milk allergy is a reaction by the body’s immune system to the protein in milk, whereas lactose intolerance is the inability to digest the sugar lactose, which is rare in infants and more common among older kids and adults.
Some parents confuse milk allergy with lactose intolerance. Milk allergy usually appears in the first year of life, whereas symptoms of lactose intolerance are uncommon before age 2 or 3 years. Most children outgrow milk allergy.
How is CMPI diagnosed?
Describing what your child is experiencing to the physician is very important in making the diagnosis of this disease. The timing of the symptoms in relation to starting feeds with cow’s milk protein is also a key in diagnosis. Whether there is a family history of allergies, asthma, or eczema can be helpful for diagnosis.
CMPI also is diagnosed after seeing how your child responds to the elimination of cow’s milk from the diet.
What tests are needed to diagnose CMPI?
Blood tests and other invasive studies are not always helpful in diagnosing cow’s milk protein intolerance. Checking for blood in the stool of infants suspected of having CMPI can be helpful in diagnosing this disorder. Your physician may recommend tests to exclude other problems.
What is the treatment?
In breastfed infants with CMPI, the mother must exclude all dairy and soy products from her diet and continue breastfeed. This may be difficult, and is helped by having a dietitian discuss hidden sources of dairy and soy with the mother prior to starting the elimination diet.
Giving goat’s milk or sheep’s milk will not improve CMPI. Soy milk also is not recommended. Many infants will have similar allergic reactions to the proteins in these milks or soy-based formula.
The treatment of CMPI includes eliminating cow’s milk protein from the infant’s diet. Elimination diets are usually started with extensively hydrolyzed formulas. These formulas are made up of broken down proteins and can be digested without an immune reaction. These formulas will work in most of patients (90%) with CMPI. In some patients, it is necessary to use amino-acid (building blocks of proteins) based formulas.
Will my child outgrow CMPI?
Cow’s milk protein allergy resolves in 50% of infants by the age 1 year, and more than 75% by 3 years and more than 90% by 6 years of age.
Most infants that are started on cow’s milk-free formulas or breastfed by a mother on a cow’s milk-free diet will need to remain on the diet for about 6-12 months. At that point, the child can be challenged with cow’s milk, and if they have no reactions, milk can be put back into the child’s diet.
(The writer is a Paediatric
Gastroenterologist and Surgeon, Narayana Health City)