By Dr. Sunita Rajani
What does the word allergy remind you of? Nuts/ pollen/ dust? But have you heard of being allergic to milk? There could be times when you or your baby could react to even the most simplest food – the humble milk. Nothing to be alarmed about, it is just about being aware and knowing that something as simple as cow’s milk (or any bovine milk) may not always agree with everyone.
**Cow’s milk protein allergy is a fairly common condition seen in infants and older children worldwide, unfortunately, it lacks recognition in our country. While it is a well-known condition in several parts of the world, yet it still lacks recognition and awareness in our country.
Recently I recognized this problem in my friend’s baby which led me to create awareness about this condition. It is entirely different from lactose intolerance wherein our body does not produce enough enzymes to digest lactose and it presents as watery stools and perianal redness.
Milk is the first foreign protein introduced to an infant. What happens in this condition is that, our body recognises the proteins in milk as harmful and elicits an immune response causing various symptoms. In simplest terms, our body recognises milk protein as an enemy and fights against the enemy generating symptoms.
It can present as early as in the new born period or at an older age. Breast fed infants can also present with symptoms if the mother is consuming milk in her diet. This is the trickiest category to diagnose as one wouldn’t think of it as a possibility as the child is on exclusive breast milk.
Symptoms to look out for are when babies cry excessively, have severe colic, have blood in stools, restlessness, inconsolable crying, refusal to feed, reflux, constipation etc. In older children, symptoms can range from poor weight gain, wheezing, coughing, vomiting, diarrhoea, hives, itchy, watery, or swollen eyes and light headedness. In extremely rare cases they can have anaphylaxis too which is a potentially severe or life threatening reaction that can rapidly occur after contact with the allergen. Symptoms of anaphylaxis can range from being mild such as hives, itching, flushing to something severe like difficulty in breathing, swelling of lips and feeling uneasy.
The preferred method for diagnosis is elimination diet for 4-6 weeks, followed by an oral challenge after a period of stabilisation.
The treatment for this condition is to avoid any form of milk protein in the child’s diet. For babies who are breast feeding, their mothers need to avoid all forms of milk protein right from biscuits, cakes, rusks, yoghurt, cheese, any other animal milk, vegetables cooked with butter/cheese, pancakes, bakery items, puddings, kheer etc.
For infants on formula feed you can switch to hypoallergic formulas. There are two types of formula, extensively hydrolysed and Amino acid based. Amino acid formulas are preferred as they have proteins broken down to simplest form for easy tolerance and digestion. These products are not easily available in India yet, however, two companies are launching their products soon in India. Hypoallergenic milk is expensive costing more than three times the price of standard formula feeds so it needs to be used judiciously.
Soya based formulas which are extensively used in our country are ideally recommended only after 6 months of age. Soya has cross reactivity with milk protein and also high concentration of phytate which can produce undesirable side effects. In children older than 6 months where cost is an issue soya formulas can be used.
An elimination diet is recommended for at least 6 months or until the age of 9-12 months. When on elimination diet it is essential to maintain calcium requirement by giving age appropriate supplements.
Children generally outgrow milk protein allergy by one year and some later in life by 6 years whereas a small percentage can continue to have lifelong milk allergy. Milk protein can be introduced gradually once the child is stable to try and see if it is tolerated. In babies who are feeding it can be introduced as adding few spoons in the morning feed to gradually giving the first feed as cow’s milk and eventually every feed as cow’s milk. For older children and mothers it should be introduced in stages from baked items (e.g. muffins) to pancakes to vegetables where small amount of milk used in yoghurt/cheese/butter to items containing more milk and finally milk in its pure form.
Another aspect of this problem in our society is the contrary belief that milk is the cure for everything. Cow’s milk is the preferred weaning feed in most parts of our country. It is difficult for our society to accept that milk could be the cause of a problem and the only solution is to avoid it. This condition is very distressing for a new mum and she needs a lot of family support and hence, it needs recognition and awareness in our society.
**Note: This is not to say that all cow’s milk/ bovine milk are bad. This milk protein allergy can differ from case to case basis. Please check with your doctor/ paediatrician for more clarifications.
Dr. Sunita Rajani is a Paediatrician who is currently pursuing her super specialisation in Paediatric Gastroenterology in London. She is our first student at The Lifestyle Portal Online Writing Program.
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