Immediate cow milk allergy – what is a safe milk alternative?

Immediate cow milk allergy (CMA) occurs as the immune system produces an allergy antibody called IgE to cow milk protein(s). This means if a child is re-exposed to cow milk protein then immediately (usually within 1 hour) an allergic reaction occurs. This is different to a cow milk intolerance (which can be to the protein of cow milk and/or lactose) and usually presents as abdominal pain, bloating, nausea and/or diarrhea.

The allergic reaction in IgE mediated CMA can be non-anaphylactic (hives, swelling of the face, vomiting, tingling mouth) or anaphylactic (difficulty breathing, shortness of breath,voice change, wheeze/cough, and/or impaired conscious state). The severity of each reaction depends on multiple factors, including the volume the child drinks, the age of the child, the presence of asthma, whether the child is well at the time, and exercise to name a few.

To confirm an immediate IgE CMA a skin test or specific IgE blood test (RAST) is done.

Children with immediate CMA should not have the following milk alternatives:

  1. Lactose free cow milk (as this has cow milk protein; lactose can not cause an immediate IgE mediated allergy)
  2. Goat/sheep milk (as most children with IgE CMA will react to such milks)
  3. A2 cow milk (as this still contains whole cow milk proteins which the child can react to)
  4. Partially hydrolysed formulas, such as NAN formulas or Aptamil gold HA (as the majority of children will react to these formulas as well)

Safe alternatives must be first discussed with your doctor, especially if your child has had anaphylaxis to cow milk proteins. These alternative milks may include:

  1. Soy milk/formula
  2. Extensively hydrolysed formulas (these can be prescribed by Paediatricians/Allergists, and some brands are now available from pharmacies without script)
  3. Amino acid formulas (these are uncommonly prescribed for immediate cow milk allergy and only Allergists can prescribe such formulas. For immediate CMA it may be used when a child has reacted to both soy or extensively hydrolysed formulas, or if the infant has presented with cow milk anaphylaxis)
  4. Other milk such as almond, oats, rice may be used, but ONLY after careful discussion with your doctor (as some of these milks are potentially poor sources of protein and calcium)

More on immediate cow milk allergy to come…..

Dr Mehr