Cow’s milk protein allergy: From diagnosis to treatment

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At a paediatrics conference at the University of Cape Town, world-renowned researcher Professor Yvan Vandenplas presented on the diagnosis and treatment of cow’s milk protein allergy (CMPA). 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 equals a happy mommy.

Even though the prevalence of cow’s milk protein allergy is only between 5% and 15%, it remains a condition that is quite tricky to diagnose and treat. 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 in Europe this term refers to formula with a reduced allergenicity (referring to partially hydrolysed formulas), but in the USA it refers to formula that has been proven to be effective in the treatment of CMPA?

“Many babies suffer from allergies; however, their condition is often misdiagnosed or adequately treated.”

It is important to realise this difference because we often think that an “HA formula” (those that are only a partially hydrolysed formula) is effective in treating CMPA, yet they’re 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 that 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).

Many moms have spent many hours at hospitals without getting answers as to why their 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 (signs that a particular disease is present beyond any doubt) for CMPA and 90% of infants develop symptoms before the age of three months or within two months after the introduction of cow’s milk protein. CMPA rarely develops after the age of 12 months as the immune system has by that stage built up a tolerance to the protein.

The most frequent symptoms of CMPA to look out for:

  • Gastrointestinal (59%)

    • Frequent regurgitation/vomiting
    • Diarrhoea/constipation
    • Blood in stool
  • Dermatological (63%)

    • Atopic dermatitis
    • Swelling of lips or eyelids (angioedema)
    • Urticaria (hives unrelated to acute infections, drugs or other causes)
  • Respiratory (33%)

    • Runny nose
    • Chronic cough
    • Wheezing (unrelated to infection)
  • General

    • Persistent distress or colic

The one symptom that should raise red flags and could indicate that your 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 with dietary management (unwillingness to expand the diet)
  • Extreme self-limitation of food
  • Association with atopic diseases (asthma, atopic eczema) or with chronic diseases

You can suspect that your baby has CMPA when:

  • Symptoms develop within two months after the introduction of cow’s milk.
  • Symptoms develop within two hours after ingestion.
  • More than one organ system involved.
  • There is a family history of atopy (genetic tendency to develop allergic diseases).

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 or 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.

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 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. The first choice of treatment is an extensively hydrolysed cow’s-milk-based formula due to its proven efficacy. 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. It would appear that Novalac Allernova Smooth is the superior product to use. Vandenplas also mentioned the role of amino-acid-based formula, which should be used for severe CMPAs; however, these products are often very costly.

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.

Also read:

What is a cow’s milk protein allergy?
Why formula feeding a baby is so confusing