General Paediatrics, Asthma and Allergy

Dr John Chapman   FRCPCH
  Consultant Paediatrician (NHS & Private)

Making sick children better.

Cow's Milk Protein Allergy

eczema asthma allergies hay fever skin blood tests

Cows milk protein allergy (CMPA) or Milk allergy.


This is the commonest allergy but one that thankfully most children will grow out of.


Use the term ALLERGY not Intolerance.

 

Milk is complicated stuff. It is mixture of proteins, fats and sugars (lactose). If you of your child is allergic to milk then you will be allergic to one of the PROTEINS.

 

Lactose problems are very rare in babies and very different to allergy. Read my Lactose Intolerance page.

 

If a baby Is milk allergic then it is allergic to its entire diet. Even breast milk will contain cows milk protein if a mother is eating or drinking milk products.

 

The milk proteins are very complex structures. They are a bit like a string tied into a very intricate knot.

 

Fresh cows milk is the most allergenic. As the milk is processed or heated it becomes less allergenic. As the milk protein is heated, it twists into a different shape and the allergic bit (the allergic epitope) becomes more hidden within the structure of the protein. 

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There are two main types of CMPA defined by whether allergy skin or blood tests are positive for CMPA. These tests detect the presence of allergy antibodies (IgE). The types are called IgE-mediated CMPA and Non-IgE-mediated CMPA.  As a general rule, the two types cause different systems but often children will have symptoms suggestive of both types.

 

The most important part of making a diagnosis of any allergy is the "history". The history is just the term used by medics for the story of the illness and any other relevant illnesses. A family history of allergic or atopic illnesses is also very suggestive of allergy.

 

Typically, IgE mediated CMPA causes very quick reactions such as redness, swelling and rashes on contact. It can cause rapid vomiting and breathing difficulties even to the point of anaphylaxis (severe allergy). Eczema is also common. Why?

 

Typically, non-IgE mediated CMPA causes slower and more subtle reactions such as constant vomiting (gastro oesophageal reflux GOR), unsettled behaviour, snotty nose and eczema.

 

If I see a baby with feeding issues and eczema (even cradle cap is a form of eczema) then I assume the child had CMPA until proven otherwise.

 


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Dealing with CMPA

 

First rule: don't drink it, eat it or have any skin contact with it.

 

Second rule: have some antihistamine medicine available in case you break the first rule.

 

Third rule: be patient because almost everyone grows out of their CMPA, usually by the age of 2-3 years.

 

Has my child's CMPA gone away?

 

If you are very good at following the First rule then you will not know if your child's CMPA is fading away.

 

In clinic we would usually repeat a milk allergy skin prick test (SPT) at the age of 12 months or so. If it is strongly positive then we would repeat it again in 6 months.

When the SPT suggests that the CMPA is settling, we would recommend introduction of cooked cows milk in the form of a malted milk biscuit. Our dieticians have a protocol for this and, when the biscuit is tolerated, they would encourage full cows milk introduction using a "milk ladder".

 

Things to remember

 

Babies who are allergic to milk are allergic to their entire diet.


Breast milk (from a CMP-free mother) is best.

 

CMPA may be the first sign of allergy.

 

CMPA often comes with other allergies particularly egg.


Goats milk is almost the same as Cows milk. Your will probably react to it also. Stay safe and save your money!

 

Getting good advice about avoidance and reintroduction can make a big difference to the current and future health of your child.


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