Cows milk protein allergy

Table of contents

    What is cow’s milk protein allergy?

    Cows milk allergy (CMA) or sometimes referred to as 'Cow’s milk protein allergy (CMPA)’ is a reaction by the immune system to the proteins found in all mammalian milks including cow, goat, sheep, buffalo etc. CMPA is different to lactose intolerance, which does not involve the immune system. CMPA typically develops in early infancy, either following first exposure to a cows’ milk protein-based formula, or at the time of weaning, when cows’ milk based products are introduced into the diet.

    CMPA is one of the most frequent causes of food allergies in young children with an estimated prevalence between 1.9% and 4.9% in the first year of life. Most children out-grow the allergy by the age of 5 years.

    What to recommend to your patients with cow’s milk protein allergy

    Any infant or child who is suspected of having CMPA should be immediately referred to a specialist dietitian and specialist pediatric team to confirm diagnosis and for further advice as often there are other complications. The information below is a guidance only.

    Milk substitutes for CMPA

    The decision as to which cow’s milk substitute to choose for CMPA patients will depend on clinical presentation, severity and any other food allergies. IgE mediated (immediate allergic reaction) or non IgE mediated (delayed reaction) will also be considered.

    CMPA is managed by excluding cow's milk protein from the diet; either a maternal exclusion is required or a prescribed hypoallergenic formula. NICE recommends that the advice of a dietitian with appropriate competencies should be sought to assist with nutritional adequacies, timings of elimination and reintroduction, and follow-up.

    ALPRO PRODUCTS AND CMPA

    All Alpro products are free from milk protein and lactose. If the infant or child does not have concominant soya allergy. Unsweetened calcium fortified Alpro drinks can be introduced from the age of 1 as part of a healthy balanced diet.

    Alpro soya alternatives to yogurt: source of high quality protein and fortified with calcium and vitamins B12 and D. Available inunsweetened and low sugars plain variants which could be used alongside a varied, healthy, balanced diet.

    Alpro soya alternatives to cream: soya alternatives are available.

    References:

    1. Kemp AS, Hill DJ, Allen KJ et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensuspanel opinion. Med J Aust 2008;188:109-12.

    2. Vandenplas Y, De GE, Devreker T. Treatment of Cow's Milk Protein Allergy. Pediatr Gastroenterol Hepatol Nutr 2014;17:1-5.

    3. Kattan JD, Cocco RR, Jarvinen KM. Milk and soya allergy. Pediatr Clin North Am 2011;58:407-26.

    4. Crittenden RG, Bennett LE. Cow's milk allergy: a complex disorder. J Am Coll Nutr 2005;24:582S-91S.

    5. Bahna SL. Cow's milk allergy versus cow milk intolerance. Ann Allergy Asthma Immunol 2002;89:56-60.

    6. Vandenplas Y, Castrellon PG, Rivas R et al. Safety of soya-based infant formulas in children. Br J Nutr 2014;111:1340-60.

    7. NHS. Types of formula [Online]. 2023. Available at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/types-of-formula/#:~:text=Soya%20formula%20is%20suitable%20from,fact%20that%20soya%20contains%20phytoestrogens.[Accessed: November 2023].

    8. National Institute for Health and Care Excellence. Cow's milk allergy in children. [Online]. 2023. Available at: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/

    9. Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT; Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). BSACI guideline for the diagnosis and management of cow's milk allergy. Clin Exp Allergy. 2014;44(5):642-72. doi: 10.1111/cea.12302. PMID: 24588904.

    10. Fox A et al. An update to the Milk Allergy in Primary Care guideline. Clin Transl Allergy. 2019 Aug 12;9:40.

    11. Vandenplas et al. An ESPGHAN position paper on the diagnosis, management and prevention of cow's milk allergy. Journal of Pediatric Gastroenterology and Nutrition ():10.1097/MPG.0000000000003897, July 26, 2023.

    12. Muraro A et al. Managing food allergy: GA2LEN guideline 2022. World Allergy Organisation Journal. 2022; 15: 100687

    13. Office for Health Improvement & Disparities. Feeding young children aged 1 to 5 years - summary report. [Online]. 2023. Available at: https://www.gov.uk/government/publications/sacn-report-feeding-young-children-aged-1-to-5-years/feeding-young-children-aged-1-to-5-years-summary-report

    Factsheet Koemelkeiwitallergie

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