Cow’s milk protein allergy is an abnormal response of the immune system reacting to the protein found in cow’s milk. The immune system detects the cow’s milk protein as harmful and works actively to attack and remove the substance. It is estimated that 1 in 20 children younger than 12 years old has a food allergy in Singapore. Cow’s milk protein allergy may be the second most common food allergy in Singapore.

Section 1: Understanding Cow’s Milk Allergy

Cow’s milk protein allergy is different from lactose intolerance. In lactose intolerance, it does not involve the immune system. The body is unable to digest lactose due to the lack of a digestive enzyme called lactase enzyme. The most common symptoms of milk intolerance are related to gastrointestinal discomfort such as bloating, gas, diarrhea and abdominal cramps.

On the other hand, cow’s milk allergy involves the immune system. There are two types of protein in milk which are casein and whey, both of which can cause an allergic reaction. If a baby is breastfed and experiences an allergic reaction, it is caused by the proteins from a mother’s dairy intake that pass through the breast milk. If the baby is fed on formula, the proteins are from the formula. There are two types of cow’s milk protein allergy:

IgE-mediated food allergy (immediate)

Symptoms appear within 2 hours after consumption
Symptoms caused by immunoglobulin E antibodies.
Symptoms include hives (raised red bumps), an itchy rash (similar to eczema or dermatitis), stomach pain, swelling of lips, vomiting of the face and eyes, and diarrhoea.
In severe anaphylaxis, wheezing, tight throat, hoarse voice and floppy baby

Non-IgE mediated food allergy (delayed).

Symptoms develop slowly, up to 72 hours after consumption
Reaction is caused by different parts of the immune system.
Symptoms appear after 2 hours or more as eczema, delayed vomiting and diarrhea.

Section 2: Nutritional Considerations

It can be daunting to navigate through food allergies with your little one. Children with cow’s milk protein allergy have an overactive immune system which can affect the maturation of their immune system. This can lead to an increased risk of developing allergies and malnutrition. Without proper dietetic support, it may lead to smaller and shorter growth in these children as compared to children without any allergy.

Some of the nutrients that are at risk of being deficient when applying a cow’s milk protein elimination diet are protein, calcium, iodine, vitamin D, vitamin B12, vitaminA, phosphorus and riboflavin. Thus, close monitoring and support by dietitians and healthcare providers will provide appropriate elimination diets which ensure sufficient energy and nutrient intake for your little one.

Section 3: Dietary Considerations

That being said, one of the skill sets that you would learn to master from a Dietitian is reading nutritional labels. Being able to read and understand food labels will be important in the effective exclusion of all cow’s milk and dairy products from the diet, as some children may react to milk proteins that are present in foods. Heating processes can make cow’s milk protein more tolerable for some children, but it may still affect others. Some of the words used in the ingredients list that mean dairy are:

Butter, butter fat, buttermilk, casein, condensed milk, cream, curds, custard, lactalbumin, lactoglobulin, malted milk, milk solids, non-fat milk solids, sour cream, whey

Apart from the obvious dairy products to avoid, like milk, yoghurt, cheese and cream, here are some products that contain dairy that you may not have thought of that contains milk or dairy products:

Bread
Muffins
Pasta
Pizza
Soups
Instant Mashed Potatoes
Pancakes
Cakes
Pudding/Custards
Chocolate
Granola bars
Hot dog
Tomato sauce
Potato chips
Chewing gum

Unfortunately, non-dairy or lactose-free does not mean dairy-free. It is also important to note that other animal milk proteins, such as goat’s, sheep’s, and camel’s milk, would cause similar reactions to cow’s milk. Thus, it is best avoided.

If you are breastfeeding, it would be wise to take a closer look at the ingredient list of food products and drinks for lactation that are regularly consumed. It may be worthwhile to consider removing cow’s milk and dairy-containing products from your own diet, as milk protein can be passed through your breast milk during feeding. You can do this for a trial period to see if your baby’s symptoms improve.

If your baby is formula-fed, it would be wise to seek advice from your paediatrician on alternative formulas that may be more suitable and tolerated. Here are some alternative kinds of milk for babies up to 1 year of age that may be considered under the supervision of a paediatrician and dietitian:

Soy protein formula
Cow’s milk-based extensively hydrolysed formula (EHF)
Rice protein-based formula
Amino acid-based formula ( if EHF and soy protein formula is not tolerated)

Conclusion

Fortunately, 80% of children in Singapore with cow’s milk protein allergies outgrow the allergy by the age of 3. Do remember that help is available. If you suspect your little one developing symptoms of a food allergy, seek consultation from your pediatrician and dietitian and work closely with them. Early detection and treatment will help provide your little one with the best possible growth

Author

Eunice Tan, In-house Dietitian

Eunice Tan graduated with a Bachelor of Science (Hons) in Dietetics with Nutrition from International Medical University. She is a certified Prenatal Dietitian, Accredited by Singapore Nutrition and Dietetics Association and also the in-house dietitian for Tian Wei Signature and ReLacto. With her expertise and interest in nutrition for women and diet planning, Eunice helps to support mothers get the key nutrients they need for recovery and lactation.

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