Cow’s milk protein allergy

Cow’s milk protein allergy

What is cow’s milk protein allergy?

Cow’s milk protein allergy (CMPA) is a reaction by the immune system to the proteins found in all mammalian milks including cow, goat, sheep, buffalo etc. CMPA is different to lactose intolerance, which does not involve the immune system. CMPA typically develops in early infancy, either following first exposure to a cows’ milk protein-based formula, or at the time of weaning, when cows’ milk based products are introduced into the diet.

CMPA is one of the most frequent causes of food allergies in young children with an estimated prevalence between 1.9% and 4.9% in the first year of life. Most children out-grow the allergy by the age of 5 years.

Poor growth is common in children with CMPA during their first year of life, so as well as an accurate diagnosis, appropriate dietary treatment is vital, including the right choice of formula, to ensure adequate nutrition is provided to support optimal weight gain and growth. Any infant or child suspected to have CMPA should be referred to a specialist registered dietitian.

What to recommend to your patients with cow’s milk protein allergy

Any infant or child who is suspected of having CMPA should be immediately referred to a specialist dietitian and specialist paediatric team for any advice as often there are other complications. The information below is a guidance only.

Milk substitutes for CMPA

The decision as to which cow’s milk substitute to choose for CMPA patients will depend on whether the allergy is IgE mediated (immediate allergic reaction) or non-IgE mediated (delayed reaction).

IgE vs. non IgE-mediated CMPA: The prevalence of associated soya allergy in infants with CMPA differs between IgE and non-IgE-mediated disease. Estimates are that 10% - 14% of infants with IgE-mediated CMPA have associated soya allergy, whereas up to 50% of infants with non-IgE-mediated CMPA are allergic to soya (especially in infants with gastrointestinal symptoms).

· 0-6 months of age. The World Allergy Organisation published guidelines recommending hypoallergenic formulae as the preferred choice for infants with CMPA. However, in infants over 6 months with IgE-mediated CMPA, without associated soya allergy, soya infant formula can be used. It is generally agreed that soya infant formula is considerably more palatable and less expensive than hypoallergenic formulae. A wealth of data show that there are no significant differences in growth, development, or health among infants fed soya infant formula compared with infants fed cow’s milk formula during the first year of life.

· During weaning, calcium fortified soya and other plant-based drinks – with the exception of rice drink – can be used in cooking and food preparation, but should not be used as a main drink.

· From age 1. Depending on the child’s growth and development, calcium fortified soya and other plant-based drinks – with the exception of rice drink – could be used as the main drink. However, advice from their specialist dietitian should be sought as some children with CMPA may need to remain on formula or other specialised milk replacers. Rice drinks should not be introduced prior to the age of 5.

Alpro soya Growing Up drink specifically formulated for 1-3 year olds. This product is specifically designed to meet the nutritional needs of children more than one year of age. It is more energy dense and fortified with iron, iodine, calcium and the vitamins B2, B12, C and D.

A 250ml daily serving of Alpro Soya 1-3+ will meet the following UK dietary reference values for 1-3 year olds:

· Over 75% iodine, calcium and iron requirements

· 38% of their vitamin D needs

· All of their vitamin B12 and C needs

88% of their riboflavin requirements 

Now available in 1L chilled cartons, 1L and 250ml UHT cartons.

For more information click here

Alpro Products and CMPA

All Alpro products are free from milk protein and lactose. If the infant or child does not have concominant soya allergy, Alpro products can be introduced from weaning to provide variety to their diet.

Alpro soya alternatives to yogurt: source of high quality protein and fortified with calcium and vitamins B12 and D. Available in unsweetened and low sugars plain variants as well as a variety of fruit and ‘no-bits’ flavours.

Alpro soya alternatives to Greek-style yogurt: a thicker and richer source of high quality protein and fortified with calcium and vitamins B12 and D. Available in plain and fruit fruit flavours.

Alpro soya desserts and custard: a deliciously dairy free custard and desserts in 4 flavours: sweet creamy caramel, devilishly dark chocolate, silky smooth chocolate and heavenly velvet vanilla. All fortified with calcium and vitamins B12 and D.

Alpro plant-based alternatives to cream: choose between soya or coconut cream alternatives.

Alpro ice creams: available in vanilla, coconut, hazelnut-chocolate and almond salted caramel.

References

Kemp AS, Hill DJ, Allen KJ et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust 2008;188:109-12.

Vandenplas Y, De GE, Devreker T. Treatment of Cow's Milk Protein Allergy. Pediatr Gastroenterol Hepatol Nutr 2014;17:1-5.

Kattan JD, Cocco RR, Jarvinen KM. Milk and soya allergy. Pediatr Clin North Am 2011;58:407-26.

Crittenden RG, Bennett LE. Cow's milk allergy: a complex disorder. J Am Coll Nutr 2005;24:582S-91S.

Bahna SL. Cow's milk allergy versus cow milk intolerance. Ann Allergy Asthma Immunol 2002;89:56-60.

Vandenplas Y, Castrellon PG, Rivas R et al. Safety of soya-based infant formulas in children. Br J Nutr 2014;111:1340-60.