Cow's milk allergy - reducing morbidity in infants

Dr Joe Kosterich examines the increasing incidence of Cow's Milk Protein Allergy (CMPA), what to look out for and the role of the specialist and GP in reducing the morbidity associated with CMPA.

  The incidence of Cow's milk (dairy) protein allergy (CMPA) is in Australia is estimated at 2% of those under two years old. This figure has increased in recent years and this is thought to be a combination of a real increase and more awareness leading to more cases being diagnosed. The good news is that the vast majority will have “outgrown” the problem by age four, and although symptoms may persist in some beyond this, it is very rare in adults.

  It is important to note that a true allergy is not the same as finding that dairy products “do not agree” with someone. True cow’s milk allergy also needs to be differentiated from lactose intolerance which is the lack of the enzyme lactase needed to digest the sugar lactose.

  So, how can you tell which the child is suffering from? The symptoms in children vary from mild to severe and include eczematous rash, swelling, vomiting and /or diarrhoea, noisy breathing, even asthma. Young infants can also have non-specific symptoms of irritability and floppiness. In the most severe cases, which fortunately is rare, hives and anaphylaxis can occur. The onset of symptoms can be from within minutes to some hours so accurate diagnosis is essential.

  The reactions can be either IgE mediated (with the more classic symptoms outlined above) or non IgE mediated. The latter form may present as enterocolitis or proctocoltis. This may present with diarrhoea and sometimes rectal bleeding. However, these are relatively non-specific and many presentations can occur before the diagnosis is made. Some children may purely present with a general failure to thrive.

 Sometimes, particularly when the reactions start soon after ingestion, the clinical diagnosis is apparent. Symptoms reliably follow exposure and removing dairy from the diet leads to symptom resolution. But, medicine is rarely this straight forward. Allergy tests can be done with skin patch testing, and this is generally best done by a paediatric allergist or immunologist. Referral should be considered in all cases.

 Accurate diagnosis is essential as treatment is relatively simple. Incorrect diagnosis or assumption can lead to unnecessary dietary restriction, and now more than ever we are seeing cases where parents are seduced by unproven diagnostics promoted by the results of Dr ‘Dreadful’ Google.

  Treatment is removal of dairy products from the diet. Whilst this sounds simple it can be challenging for parents given the number of dairy products that children often consume (think milk, cheese, yoghurt, ice cream) and the fact that dairy may be in a variety of other processed foods. Reading labels becomes imperative. There can also be cross reaction with goat’s milk, so often parents are advised to avoid these products as well. Fortunately, most cases are mild and occasional dietary lapses are not a major problem. It is important to note that the A2 milk which is promoted as being “healthier” is not a suitable substitute – it’s still cow's milk.

  By the time children turn five, you’ll find that most will no longer be allergic. Retesting can be done by an allergist/immunologist depending on the severity of the original symptoms, and then consideration can then be given to reintroducing dairy products. It’s important to remember when managing CMPA that dietary changes are often best initiated by a specialist, leaving you, the GP, to help with support and re-enforcement. Working together is of high benefit to everyone involved, and essential in reducing the morbidity associated with CMPA in infants.

 To learn more about CMPA in infants click here

Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.