Infant Milk Allergy & Cow's Milk Allergy

What is Cow’s Milk allergy?

There are a number of common allergens that cause an allergic reaction in childhood.  Having an allergic reaction to cow’s milk is one of the most common in Australian children, but there is often confusion whether the child’s reactions are due to an allergy or intolerance, as many of the symptoms can be the same. This is why it’s so important to seek medical advice as soon as possible when your child has an adverse or allergic reaction to cow’s milk. Getting the right treatment is important. 

If your child has a severe reaction, seek immediate medical attention.

What’s the difference between an infant milk allergy and lactose intolerance?

Cow’s milk protein allergy in infants occurs when the immune system reacts to the protein found in cow’s milk. Around 2% of Australian infants are allergic to cow’s milk and dairy products, and while most will grow out of it by school age, some may have it for life.

Cow’s milk intolerance on the other hand is not an immune response, it’s a reaction to the sugar in milk (lactose). This is often referred to as Lactose Intolerance.

It is sometimes not easy to recognise the difference between an allergy or intolerance as the signs vary and may be confused with other conditions. It’s important to always get a medical diagnosis.

What are some common symptoms of an infant milk allergy?

Cow’s milk protein allergy in infants can result in immediate (within 15 minutes) or delayed (after about 2 hours) reactions and range from mild to severe.  Some of the symptoms may include:

• Skin: hives, eczema, redness or paleness in the face, oedema (swelling), infant milk rash;
• Digestive: regurgitation, vomiting, diarrhoea, stomach pain;
• Respiratory: wheezy cough, asthma, difficulty breathing. Seek immediate medical attention if your child is experiencing any respiratory symptoms or if you are concerned about your baby’s symptoms.

Symptoms of lactose intolerance in infants

Sometimes lactose intolerance can be mistakenly called an allergy when it is not. Lactose intolerance does not involve your immune system, it involves sensitivities to one part of food – Lactose. Symptoms of lactose intolerance often occur 30 minutes to 2 hours after your baby eats or drinks milk products and may include the following symptoms:

• Acute and irritable diarrhoea that can be frothy, or
• Nappy rash;
• Abdominal pain;
• Excessive wind or bloating;
• Nausea;
• Irritable behaviour;
• Restless sleep.

How is a cow’s milk protein allergy in infants diagnosed?

Cow's milk allergy in babies is typically diagnosed through a combination of:

• medical history,
• physical examination, and
• diagnostic tests performed by your doctor, paediatrician or allergist.

Your doctor or paediatrician will review your baby's symptoms and may recommend eliminating cow's milk and dairy products from your baby's diet to see if the symptoms improve.

If there is a suspected allergy, further tests such as:

• skin prick tests,
• blood tests, or
• oral food challenge

may be performed under specialist medical supervision to determine if your baby has a true allergy to cow's milk.

How can an infant milk allergy be treated?

Whilst it can be hard to see your child in discomfort, there are steps to help manage your little one’s allergy. To start with, seeking medical advice upfront is important. Your doctor will determine the most appropriate feeding plan for your infant to help manage your baby’s milk allergy at home.

Managing a milk allergy at home

1. Removing all cow’s milk and dairy from your child’s diet, if your child is already on solids. Your healthcare professional can also give you advice on how to achieve an adequate calcium intake in your child’s diet. If you are breastfeeding, it is important to continue where possible.
2. Reviewing a breastfeeding mum’s diet. In some cases, a mum might be advised by their healthcare professional to limit or exclude intake of dairy from her diet as small amounts of dairy protein may pass through the breast milk. This is not common. If you need to exclude dairy from your diet, there are many alternative non-dairy ‘milks’ available including oat and nut milks, that are fortified with calcium.
3. Reviewing the formula being fed to baby. If your baby is formula fed, a doctor or paediatric allergist will advise you on which formula is best for your baby. They may prescribe an extensively hydrolysed-protein formula, or an amino acid formula. The protein in these formulas are broken down to a size where the immune system no longer over-reacts to it. These special formulas are as nutrient-rich as standard infant formula and will contribute just as effectively to your baby’s growth. Other alternative formulas include soy (for over 6 months old), and rice infant formulas.

When to seek further medical treatment

Knowing when to seek further medical treatment for your baby’s allergies is crucial. If you have already removed all dairy products from both your and your baby's diet, yet symptoms such as rashes or gastrointestinal issues still persist, it is important to contact your doctor for further evaluation or seek emergency medical treatment if you’re concerned. Persistent symptoms may indicate that additional allergens are at play or that your child may require a more tailored management plan. If you are not already seeing a specialist paediatrician now might be the time to get that referral. Paediatric allergists and immunologists specialise in diagnosing and treating allergies in children. Additionally, a paediatric gastroenterologist may provide valuable insights if gastrointestinal symptoms are prominent. Early intervention and specialised care can significantly improve your child's quality of life and overall health.

What happens if my child doesn’t outgrow an infant milk allergy?

While it is relatively uncommon, some infants with milk allergies may continue to experience symptoms into toddlerhood, and even last into adulthood. As you continue to monitor your child’s progress, it’s important to stay proactive in managing your child's changing dietary needs as they grow. 

How to support a toddler with a milk allergy

In addition to the strategies you already have in place since your baby was diagnosed with a cow’s milk allergy, there are a few additional strategies that may support your toddler further, including:

• Introduce alternative milks: From one year of age, toddlers can consume alternative milk options as their milk drink, such as oat or nut milks, which can provide essential nutrients.
• Read labels carefully: Always check food labels for hidden dairy ingredients to ensure that your child's meals are safe.
• Consult with a dietitian: A paediatric dietitian can help create a balanced meal plan that meets your child's growing nutritional needs while avoiding diagnosed allergens.
• Medication management: If your toddler is older than two, antihistamines may be recommended by your doctor to help alleviate symptoms.
• Educate caregivers: Ensure that all caregivers, including daycare providers, are aware of the allergy and know how to respond in case of an allergic reaction.
• Support groups: There are support groups and resources for families available. Allergy & Anaphylaxis Australia, and Australasian Society of Clinical Immunology and Allergy (ASCIA) are a great starting point.

By taking these steps, you can help ensure a safe and healthy environment for your toddler with a milk allergy.