We attended a Paediatrics conference at the University of Cape Town where world renowned researcher Professor Vandenplas presented on the diagnosis and treatment of Cow’s Milk Protein Allergy (CMPA). So many babies suffer from allergies, however their condition is often misdiagnosed or adequately treated. The stress does impact the family and we wanted to find out what can be done, as a happy baby = happy mommy.
Even though the prevalence of cow’s milk protein allergy is only between 5 – 15%, it remains a condition that is quite tricky to diagnose and treat. Professor Vandenplas started his presentation by emphasising that there is confusing terminology used when discussing allergies and which infant formulas to use as treatment.
We all are familiar with the “trendy” term “Hypo-allergenic formula”, but did you know that in Europe this terms refers to formula with a reduced allergenicity (referring to partial hydrolysed formulas), but in the USA it refers to formula that has been proven to be effective in treatment of CMPA? Why it is important to realise this difference? It is because we often think that a “HA formula”, that is only a partially hydrolysed formulas, is effective in treating CMPA, yet they are only sufficient to prevent allergies in infants with a family history of allergies. Extensively hydrolysed formulas (EHF) or amino acid based formulas (AAF) are the only formulas which can be used to treat CMPA, since the level at which the proteins are broken down ensures that the product is less allergenic (EHF) or non allergenic (AAF) .
How many moms have spent many hours at hospitals without getting answers as to why baby is so unhappy? The reality is that there is a lack of knowledge around CMPA and this often leads to misdiagnosis. This could be explained due to the non-specific nature of symptoms of CMPA along with infrequent allergy testing.
There are no pathognomonic symptoms for CMPA! A pathognomonic sign means that a particular disease is present beyond any doubt. 90% of infants develop symptoms before 3 months of age or within 2 months after introduction of cow’s milk protein. CMPA rarely develops after the age of 12 months, since by then the immune system has built up a tolerance to the protien. The most frequent symptoms of CMPA that you could look out for if you suspect your little one to have a CMPA are:
- Gastrointestinal (59%)
- Frequent regurgitation/vomiting
- Blood in stool
- Dermatological (63%)
- Atopic dermatitis
- Swelling of lips or eye lids (angio-edema)
- Urticaria (hives unrelated to acute infections, drugs, or other causes)
- Respiratory (33%)
- Runny nose
- Chronic cough
- Wheezing (unrelated to infection)
- Persistent distress or colic
The one symptom that should raise red flags and could indicate that you baby most likely has a food allergy is impaired growth or failure to thrive as the professionals refer to it. The most common risk factors leading to poor growth of children suffering from food allergies include:
- Delayed diagnosis
- Onset of disease in early age
- Multiple food allergies
- Persistent intestinal inflammation
- Elimination of most foods from the diet
- Elimination of foods with high nutritional value (milk, eggs)
- Poor compliance to dietary management (unwillingness to expand the diet)
- Extreme self-limitation of food
- Association with atopic diseases (asthma, atopic eczema) or with chronic diseases
So when can I suspect that my baby has CMPA? When symptoms develop within 2 months after the introduction of cow’s milk, when symptoms develop within 2 hours after ingestion, when more than one organ system involved and if there is a family history of atopy.
Even though you may suspect that your baby has CMPA, a confirmed diagnosis is often not as easy. There are many diagnostic tests available such as skin prick testing, patch tests along with other diagnostic tests, however the gold standard is an open food challenge. Understandably, parents are often cautious about giving foods that could provoke an allergic reaction and even with a positive test, it does not confirm the severity of the allergy.
So what are the treatment options for CMPA? It was mentioned that Soy formulas or Goat’s milk should not be used, due to cross reactivity. This means that between 10-14% of babies that are allergic to cow’s milk protein are also allergic to soy protein and 90% of babies are allergic to goat’s milk protein if they are allergic to cow’s milk protein. Who knew!
The first choice of treatment is an extensively hydrolysed, cow’s milk based formula due to its proven efficacy. Professor Vandenplas discussed a study that was conducted to show how an extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow’s milk allergy. The product that was tested was Novalac Allernova Smooth and it was said that what makes this product different to the other products on the market for CMPA, is that it is the only extensive hydrolysed formula with an added thickener. This thickening agent has shown to improve various symptoms that are often present in CMPA babies such as stool consistency, duration of crying as well as reflux. So it seems that Novalac Allernova Smooth is the superior product to use. He also mentioned the role of amino acid based formula, which should be used for severe CMPAs, however, often these products are very costly. It seems that we could expect a new Amino Acids based formula to arrive on the South Africa market later in this year, that has been shown to be superior to Neocate (which is currently the only AAF on the market), as it provides better quality of life in addition to treating a severe CMPA as effectively as Neocate. We will keep our eyes and ears open on any news on this new product!
Professor Vandenplas is a world renowned researcher and we were delighted to be able to attend the Cocktail Symposium at UCT where he presented in the diagnosis and treatment of CMPA. He is currently the Head of the Department of Paediatrics, at the Univerity Hospital Brussels (UZ Brussel). His main interests are gastro-esophageal reflux (diagnostic procedures, treatment), eosinophilic esophagitis, infant nutrition, probiotics and prebiotics, cow’s milk protein allergy, functional gastrointestinal disorders, Helicobacter pylori. He is now an associate editor of the Journal of Paediatric Gastroenterology and Nutrition.
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Disclaimer: This post is based on personal experience and personal brand preference of the content author and has in no way been paid for or sponsored. BabyYumYum reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines http://www.who.int/topics/infant_nutrition/en/ Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not applied, an infant formula may be used according to health professionals’ advice. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.