Cow’s Milk Protein Allergy

We are hearing more and more about cow’s milk protein allergy as it seems that more children are being diagnosed with this condition. Unfortunately, cow’s milk protein allergy is becoming a commonly misdiagnosed condition which is leading to increased confusion, frustration and anxiety amongst parents and families.

Up to 20-30% of children have symptoms such as reflux, regurgitation or colic and are given the diagnosis of cow’s milk protein allergy. It is suggested that only 2% of Australian children actually have an allergy to cow’s milk protein so what about the rest of the children who have been diagnosed with this allergy? What is the issue?

Food allergies are broadly classified into two types:

IgE-mediated allergy is characterised by an immediate onset of an allergic reaction where the immune system reacts by producing antibodies called Immunoglobulin E (IgE), which produce various symptoms. Symptoms can be mild to moderate (such as hives (welts on the skin), facial swelling or worsening eczema, abdominal pain, vomiting and diarrhea). However, symptoms can also be severe and lead to anaphylaxis. Signs to watch out for includes wheezing or noisy breathing, swelling of the tongue, and “floppiness” or paleness in babies. ^2,3

Non-IgE-mediated food allergy results in delayed reactions usually occurring two or more hours after consuming dairy foods, but still involve the immune system.^2,4 Symptoms often relate to the gastrointestinal tract such as reflux or regurgitation, vomiting, blood or mucus in stools, abdominal pain, constipation or loose and/or frequent stools. ^1,4

How is CMPA/ food allergy diagnosed?

Skin prick tests (SPTs) or blood tests (for serum-specific immunoglobulins E (sIgEs)) will usually show positive results for IgE-mediated food allergy, but they could also be positive in non-allergic subjects.

Oral food allergen challenges are regarded as the gold standard procedures for the diagnosis of food allergy, are standard of care in managing food allergy, and appear in practice guidelines worldwide. ^6,7 A symptom history may be confirmed by a period of allergen elimination and reintroduction into the diet i.e. symptoms improve when the suspected food is removed from the diet and return when the food is later reintroduced into the diet. ³ The process can take a number of weeks or months to complete properly and is termed the ‘eliminate-rechallenge test’, or food elimination diet.

It is recommended that the process is undertaken with the supervision of an appropriate healthcare professional such as an accredited dietitian. Breastfeeding should continue to be encouraged unless otherwise advised by the treating healthcare professional, especially in exclusively breastfeeding mothers. ⁴

If you would like to speak to a Dietitian who has extensive experience with food allergy, make an appointment today by calling our friendly admin team.

Helpful resources:

Nip Allergies in the Bub – A Food Allergy Prevention Project (preventallergies.org.au)

The Australasian Society of Clinical Immunology and Allergy (ASCIA) Cow’s Milk Diet Sheet:

https://www.allergy.org.au/patients/food-allergy

Reference List:

1. Peters RL, et al. J Allergy Clin Immunol. 2017 Jul;140(1):145-153.e8.
2. https://www.allergy.org.au/patients/food-allergy/faqs Accessed March 17. 2022.
3. Cows_milk_allergy_in_infants-HS1002.pdf (allergyfacts.org.au) Accessed March 17. 2022
4. Walsh J, et al. Br J Gen Pract. 2016;66(649):e609-e611. doi:10.3399/bjgp16X686521
5. https://www.worldallergyorganizationjournal.org/article/S1939-4551(21)00103-4/fulltext Accessed March 17. 2022
6. ASCIA Position Paper Food Allergen Challenges – Australasian Society of Clinical Immunology and Allergy (ASCIA) Accessed March 17. 2022
7. Calvani M, et al. Medicina (Kaunas). 2019;55(10):651. Published 2019 Sep 27. doi:10.3390/medicina55100651