Cows' Milk Protein Intolerance

Cows’ Milk Protein Intolerance

Cows milk protein allergy or cows’ milk protein intolerance affects around4.4% of children aged 1 year, 1.9% of those aged 2 years and 0.4% of those aged 4 years.¹

Signs and symptoms

These are wide ranging and include:

Respiratory - allergic rhinitis and asthma
Dermatological - urticaria and atopic eczema
Gastrointestinal - nausea, vomiting, diarrhoea, irritability

Infants less than 6 months

Dietary Management

Whatever the underlying cause of the problem, the treatment is the same – complete dietary exclusion of cows’ milk and foods containing cows’ milk.

For infants who are not breast fed and have not yet started weaning, parents should be advised to switch to an appropriate formula. There are now several milk substitutes available and their nutritional composition; ease of preparation, cost and availability determines choice.

Two of the more common alternatives are soya infant formula and protein hydrolysates.

In soya infant formula, the cows’ milk protein is removed and replaced with soya protein, supplemented with amino acids: L-methionine and taurine.

These formulae are nutritionally complete and must conform to strict compositional requirements laid down in European and UK legislation. Their main advantages over protein hydrolysed formulae are cost, palatability and availability.

Protein Hydrolysates have been available for over 40 years and are widely used by paediatricians in the UK. The cows’ milk protein has not been removed but instead hydrolysed (broken down) into smaller, more digestible fractions.

In the UK and ROI there are two nutrionally complete casein hydrolysed infant formulae and one whey-dominant hydrolysed infant formula.

Although these formulae are well tolerated by the majority of infants with cows’ milk protein allergy, their main drawback is poor palatability and it may be difficult to switch older infants onto this type of formula.

For information on the SMA Wysoy Product* - Click here

Parents should be advised that formulae based on sheep and goats' milk are not suitable for infants under 1 year as they are nutritionally unsuitable and will not meet an infant’s needs

Click on link to read DH guidance on goats' milk www.dh.gov.uk

Infants over 6 months

If an infant is being weaned, the choice of solid foods must be considered carefully.

Parents will need careful guidance on the types of food that are likely to contain cows’ milk protein as well as assistance in interpreting food labels. In a 2002 study only 7% of parents were able to correctly identify cows’ milk-containing products.²

However, since November 2005, food labeling rules have meant that pre-packed food sold in the UK and the EU should clearly show on the label if it contains milk or any of the ingredients of milk.³

Children usually grow out of milk allergy by the age of 3 years, but about a fifth of children who have an allergy to cows’ milk will still be allergic to it as adults.⁴

References:
1. Dean T. Prevalence of allergic disorders in early childhood. Pediatric Allergy and Immunology, 1997; 8, (10) : 27 –31

2. Joshi P et al. Interpretation of commercial food ingredient labels by parents of allergic children. J Allergy Clin Immunol 2002; 109: 1019-1021

3. www.food.gov.uk/

4. www.eatwell.gov.uk/healthissues/foodintolerance/foodintolerancetypes/milkallergy

IMPORTANT NOTICE: Breast feeding is best for babies. Infant formulae are intended to replace breast milk when mothers do not breast feed. Good maternal nutrition is important for preparation and maintenance of breast feeding. Introducing partial bottle feeding may have a negative effect on breast feeding and reversing a decision not to breast feed is difficult. You should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding. Infant formulae should always be prepared and used as directed. Unnecessary or improper use of infant formulae may present a health hazard. Social and financial implications should be considered when selecting a method of infant feeding. Soya infant formulae are intended to meet the nutritional needs of infants and children who are intolerant to cows' milk protein, lactose or sucrose. Soya infant formulae are not recommended for premature babies or those with kidney problems, where medical guidance should always be sought.

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This information is intended for use only by residents of the UK and ROI