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What You Need To Know About Cow’s Milk (Dairy) Allergy In Your Baby

Written by: Biostime Nutrition
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While breast milk is best for babies as it provides the optimal balance of nutrition, breastfeeding may not be possible for all women and infant formula may need to be introduced as an alternative. However, cow’s-milk based formulas do not always sit well with babies and in some cases, your child may have a cow’s milk allergy.

But what exactly is a cow’s milk allergy? And how do you spot the symptoms? Here’s what you need to know about cow’s milk allergies.


Proteins in cow’s milk

Casein and whey are the two main proteins found in cow’s milk1. While whey and casein both play a key role in supporting healthy growth and development2, these proteins have slightly different functions.

Casein forms a curd in the stomach, which helps to support the sustained release of amino acids3. These amino acids are essential for growth and tissue repair4. Casein also provides calcium and phosphorus for healthy bone development5.

Whey proteins, on the other hand, remain in liquid form, so they’re typically easier to digest compared to casein6. Like casein, whey proteins are rich in amino acids, which are essential for supporting muscle and tissue growth. Whey also contains immunoglobulins, which aid in the development of the immune system7.


What is a cow’s milk allergy in a baby?

Some babies are allergic to one or more of the proteins found in cow’s milk. When a baby has a cow’s milk allergy, their immune system mistakenly identifies cow’s milk proteins as harmful substances, which can trigger an immune response. When the baby’s immune system next encounters the protein, it will trigger the same immune response. While it’s not uncommon to come across a whey or casein allergies in babies, most children have outgrown cow’s milk allergies by six years of age8.


What is the difference between a cow’s milk allergy and lactose intolerance?

Although lactose intolerance and cow’s milk allergies can both be caused by cow’s milk, they’re two different conditions that have different symptoms and require different treatments.

A cow’s milk or dairy allergy is typically brought on by an abnormal immune response to cow’s milk proteins9. Whereas, lactose intolerance is caused by a deficiency of lactase, the enzyme needed to digest lactose (the sugar in milk)10.

Cow’s milk allergies and lactose intolerance affect babies differently. Cow's milk allergies may affect the skin, gastrointestinal tract and respiratory system. Whereas, lactose intolerance generally only affect the gastrointestinal system, resulting in symptoms like bloating, gas, diarrhoea and abdominal pain11.


Symptoms of a cow’s milk (dairy) allergy in babies

Cow’s milk allergy symptoms and severity can vary greatly from one baby to another. While some babies may experience symptoms within minutes of consuming cow’s milk, others may experience a reaction several hours or even days later12.

It’s not uncommon for babies with cow’s milk allergies to get a rash on their face within minutes of consuming cow’s milk. In addition to a “milk rash”, babies may also experience facial swelling, wheezing, vomiting and diarrhoea after consuming cow’s milk13.

Some children may experience a severe allergic reaction (anaphylaxis) when exposed to cow’s milk proteins14. Symptoms of a severe allergic reaction include:

  • Swelling of the lips, face, tongue and throat,
  • Difficult or noisy breathing,
  • Intense cramping and abdominal pain,
  • Vomiting and diarrhoea,
  • Paleness and floppines in infants or young children.

Anaphylactic reactions require immediate medical attention, so if you feel like your child could be experiencing a severe allergic reaction call 000 immediately and ask for an ambulance.


How to test a baby for cow’s milk allergy

If you’ve noticed your little one has been showing symptoms after consuming cow's milk, it's best to talk to your child’s doctor for a formal assessment and diagnosis.

Your child’s doctor will start by completing a physical examination of your baby to observe any signs of allergic reactions, like eczema, hives or respiratory distress15. They may also order blood and stool tests to determine whether your child has a cow’s milk allergy.

In some instances, the doctor may refer you to an allergist for specialist skin prick testing. During a skin prick test, a small amount of cow’s milk protein extract is placed on your baby’s skin, usually on the forearm or back16. The skin is then pricked with a small needle and if a raised, red bump develops at the test site, it indicates an allergic reaction to cow’s milk proteins.


What to do if your baby has a cow’s milk (dairy) allergy

The symptoms of a baby’s allergy to cow's milk vary and can range in severity from mild reactions to severe allergic reactions. Regardless of the extent of their allergy, if your baby has a confirmed cow’s milk allergy, you should immediately remove all cow’s milk products from their diet.

As most children who are allergic to cow’s milk are also allergic to other animal milks, your child may also need to avoid dairy products altogether. It is important however to ensure that your baby gets enough calcium, protein and vitamin D from non-dairy sources. Your child’s doctor should be able to suggest appropriate supplements if deemed necessary.

If your baby has a severe dairy allergy, you may be prescribed epinephrine auto-injectors which can be used if your child experiences an anaphylactic reaction. Breastfeeding mothers may also need to eliminate dairy products from their diet if their baby is displaying milk allergy symptoms.

For more information on postpartum and infant nutrition, take a look at our Parent Lounge.


References:

    1. Davoodi SH, Shahbazi R, Esmaeili S, Sohrabvandi S, Mortazavian A, Jazayeri S, et al. Health-Related Aspects of Milk Proteins. Iranian Journal of Pharmaceutical Research: IJPR [Internet]. 2016;15(3):573–91. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149046/ 
    1. Antunes IC, Bexiga R, Pinto C, Roseiro LC, Quaresma M a. G. Cow’s Milk in Human Nutrition and the Emergence of Plant-Based Milk Alternatives. Foods. 2023 Jan 1;12(1):99. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818304/  
    1. Kim J. Pre-sleep casein protein ingestion: new paradigm in post-exercise recovery nutrition. Physical Activity and Nutrition [Internet]. 2020 Jun 30;24(2):6–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451833/ 
    1. Bakshi S, Vinod Kumar Paswan, Satya Prakash Yadav, Basant Kumar Bhinchhar, Sheela Kharkwal, Rose H, et al. A comprehensive review on infant formula: nutritional and functional constituents, recent trends in processing and its impact on infants’ gut microbiota. Frontiers in Nutrition [Internet]. 2023 Jun 21;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320619/ 
    1. Ilesanmi-Oyelere BL, Kruger MC. The Role of Milk Components, Pro-, Pre-, and Synbiotic Foods in Calcium Absorption and Bone Health Maintenance [Internet]. Frontiers in Nutrition [Internet]. 2020 Sep 23;7:578702. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539038/ 
    1. Kim J. Pre-sleep casein protein ingestion: new paradigm in post-exercise recovery nutrition. Physical Activity and Nutrition [Internet]. 2020 Jun 30;24(2):6–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451833/ 
    1. Madureira AR, Pereira CI, Gomes AMP, Pintado ME, Xavier Malcata F. Bovine whey proteins – Overview on their main biological properties. Food Research International [Internet]. 2007 Dec 1;40(10):1197–211. Available from: https://www.sciencedirect.com/science/article/pii/S0963996907001251 
    1. Edwards CW, Younus MA. Cow Milk Allergy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542243/ 
    1. Lara-Villoslada F, Olivares M, Xaus J. The Balance Between Caseins and Whey Proteins in Cow’s Milk Determines its Allergenicity. Journal of Dairy Science [Internet]. 2005 May;88(5):1654–60. Available from: https://www.journalofdairyscience.org/article/S0022-0302(05)72837-X/pdf 
    1. Institute for Quality and Efficiency in Health Care. Causes and diagnosis of lactose intolerance [Internet]. Nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG); 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310263/
    1. Malik TF, Panuganti KK. Lactose Intolerance [Internet]. Nih.gov. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532285/
    1. Edwards CW, Younus MA. Cow Milk Allergy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542243/ 
    1. Healthdirect Australia. Allergic reactions to cow’s milk [Internet]. www.healthdirect.gov.au. 2020. Available from: https://www.healthdirect.gov.au/allergic-reactions-to-cows-milk 
    1. Edwards CW, Younus MA. Cow Milk Allergy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542243/ 
    1. Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, Koletzko S, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Archives of Disease in Childhood [Internet]. 2007 Oct 1;92(10):902–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083222/ 
    1. Brill H. Approach to milk protein allergy in infants. Canadian Family Physician [Internet]. 2008 Sep 1;54(9):1258–64. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553152/

Biostime Nutrition - Author

Newborn (0-12 months)