Cow’s Milk Protein Allergy (CMPA) is a body’s immune reaction to the proteins found in cow’s milk. It’s also referred to as simply, Cow’s Milk Allergy (CMA).
Feeding your baby should be a joyful bonding experience. However, when a baby develops symptoms of CMPA, feeding can become stressful and worrying for a parent.
Cow’s milk allergy is one of the most common food allergies in infants, affecting both formula-fed babies and those who are breastfed. Understanding what it is and how to recognise the first signs, can help parents seek medical advice at the earliest opportunity.
CMPA is different from lactose intolerance, which involves difficulty digesting milk sugar (lactose) rather than an immune reaction to milk protein.
How Quickly Does CMPA Start to Show?
There are two types of cows’ milk protein allergy, IgE-Mediated CMPA (Immediate) and Non-IgE Mediated CMPA (Delayed). Depending on how your baby’s immune system reacts, will determine which type they develop.
For IgE-Mediated CMPA, allergic symptoms can show within minutes, whereas Non-IgE Mediated CMPA can have a delayed reaction in young children and symptoms can show several hours to days after the ingestion of cow’s milk.
CMPA usually develops within the first few months of a baby’s life and symptoms can show in the first weeks of introducing cow’s milk products, whether through formula feeding or breast milk if the mother consumes dairy.
Recognising the Symptoms of CMPA
Understanding the symptoms of CMPA and how to recognise them allows you to determine the best course of action for your child.
The table below shows a few of the most common symptoms your baby may show if they have an allergy to cow’s milk.
| Immediate Symptoms (IgE-Mediated CMPA).Allergic reactions typically occur within minutes to a couple of hours* | Delayed Symptoms (Non-IgE Mediated CMPA).Delayed Symptoms (Non-IgE Mediated CMPA). Symptoms can appear several hours to days after consuming dairy products |
|---|---|
| Swelling of the lips, face, or eyes | Chronic diarrhea or loose stools |
| Difficulty breathing | Constipation |
| Runny nose and sneezing | Abdominal pain and bloating |
| Hives or skin rashes | Blood or mucus in stools |
| Vomiting | Eczema or persistent skin rashes |
| Low blood pressure | Reflux or frequent vomiting |
| Severe reaction requiring emergency care | Poor weight gain or weight loss |
| Irritability or excessive crying |
*If your baby has any of the immediate (IgE mediated) symptoms, then you should call NHS 111 for further advice. If you are concerned about their ability to breathe, or they are less responsive than usual, call 999 for emergency assistance.
If you suspect your baby has developed CMPA, then you should consult your nearest healthcare provider for further advice and to diagnose whether the symptoms may be due to milk allergy or another cause. Do not make any changes to your diet, or change your baby’s formula milk until you have spoken with your healthcare provider.
If you are based in Hertfordshire, you can book a General Paediatric Appointment at The Children’s Clinic.
Many symptoms of delayed allergies, such as eczema, reflux and diarrhoea are common in infants and milk allergy is only one of a number of possible causes.
How is CMPA Diagnosed?
To diagnose CMPA, your healthcare provider will first try to determine if an allergy is a possible cause of the symptoms being displayed. To do this they will ask a series of questions to understand your child’s history, and will complete a full physical examination.
For a diagnosis of CMPA to be made, symptoms have to resolve on exclusion of cow’s milk from the diet, and recur once it is reintroduced.
On occasions where the diagnosis is not clear, blood tests or skin prick tests may be required, however it is normally possible to make the diagnosis and successfully treat the condition without further testing. Your healthcare provider will also ensure that a referral to a paediatric dietician is also made, to help support weaning and attempts at reintroduction of cow’s milk into the diet as your child gets older.
Treating CMPA With A Cow’s Milk-Free Diet
Once CMPA is diagnosed, a common first treatment is to remove all cow’s milk protein from the baby’s diet.For Formula-Fed Infants:
- Children under 1 year require cow’s milk-based formulas to be replaced with a substitute hypoallergenic formula.
- Extensively hydrolysed formulas (EHF) are often recommended as they contain broken-down proteins that are less likely to trigger an immune response.
- If symptoms persist, an amino acid-based formula may be necessary.
For Breastfeeding Mothers:
- Breastfeeding mothers may need to eliminate dairy products from their diet.
- It may take a few weeks for symptoms to improve as cow’s milk protein clears from the mother’s system and the baby’s digestive tract.
Most babies outgrow CMPA by three to five years of age. However, following advice from a healthcare professional you can start to reintroduce cow’s milk into your child’s diet by following a step-by-step process called the “milk ladder” (1).
This involves introducing dairy in a baked or processed form first, before progressing to more direct dairy products like yoghurt and ice cream.
When to Consult a Healthcare Provider
CMPA can be challenging for parents, but with the right management and guidance from healthcare professionals, most children outgrow the allergy without long-term issues.
If you suspect your baby has cow’s milk protein allergy, consult your nearest paediatrician. If you are based in Hertfordshire, you can book a General Paediatric Appointment at The Children’s Clinic with Consultant Paediatrician Dr Felicity Taylor.
Appointments are available at Harpenden Medical and One Hatfield. Dr Felicity will take the time to listen, carry out a full assessment including an allergy-focused history and examination, and present a treatment plan to get your child back to health as quickly as possible.
If onward referral to a paediatric dietitian or allergy specialist is required, Felicity can provide advice and facilitate referrals to the most appropriate specialists.
For more information on Cow’s Milk Protein Allergy in Babies, visit the Allergy UK (2) website.
Disclaimer: This article is intended for educational purposes only and is not a substitute for professional medical advice. For personalised guidance and recommendations, please consult a qualified healthcare professional.
Allergy UK – What is a cow’s milk allergy?
https://www.allergyuk.org/about-allergy/allergy-in-childhood/cows-milk-allergy/
What is the Cow’s Milk Ladder?
https://www.allergyuk.org/resources/cows-milk-ladder/
Main Photo by Lucy Wolski on Unsplash
