Let’s talk about cow’s milk allergy in more detail…
Cow’s milk allergy is one of the most common allergies seen in infants and children. A cow’s milk allergy is an immune response to the proteins found in cow’s milk, most common being casein and whey.
It can be an incredibly daunting and overwhelming trying to work out if your bub has a milk allergy. So let’s go into more detail…
Two types!
Yep when it comes to milk allergy or other food allergies there are 2 types;
IgE mediated (immediate) or
Non IgE mediated (delayed)
These both involve the immune system but use different pathways and mechanisms.
Delayed milk allergy often gets confused with lactose intolerance which does not involve the immune system. I have seen delayed cow’s milk allergy referred to as CMPI (this is a BIG bug bear for me as this isn’t a thing!).
I get that it can be easy to confuse milk allergy with lactose intolerance as they both involve milk, but where lactose intolerance differs is it does not involve the immune system and is to do with the sugar in milk. It’s actually quite rare in infants. We sometimes see secondary lactose intolerance in bubs due to a bout of gastroenteritis, but this is transient and resolves within 4-8 weeks after following a low lactose diet.
So lets get back to IgE and non IgE mediated allergy and the difference…
IgE Mediated Symptoms
These symptoms will present quickly, within minutes but can be up to 2 hours after ingesting milk. Most reactions are seen within 30 minutes. The symptoms can range from mild to severe (life threatening).
Mild reactions can include red rash or hives, to lip or facial swelling. Other symptoms include diarrhoea, vomiting as well as stomach pain. Acute eczema flares can also present.
More severe symptoms include swollen tongue, breathing difficulties or those affecting circulation, in bubs this could be pale and floppiness. These are symptoms of anaphylaxis and adrenaline needs to be administered. In infants anaphylaxis is not common, if a little one does have IgE mediated symptoms they tend to be mild-moderate reactions.
Non IgE Mediated Symptoms
Delayed reactions will present from 2 hours but can be up to days after. Symptoms tend to be in relation to the gut but can also cause skin symptoms. Gut symptoms can include loose stools containing blood or mucus or constipation, reflux, colic, agitation and irritability.
This type of allergy can be trickier to diagnose as some of the symptoms can present in the first year of life without being in relation to allergy (e.g reflux, colic and constipation) and its best to talk through with a HCP to understand if these symptoms are in relation to allergy or not.
Other symptoms can affect the skin such as eczema, reddening and non-specific rashes. There can also be symptoms of food refusal and aversion too.
A mixture of IgE and non IgE mediated symptoms
For some infants, there can be a mixed presentation of both immediate and delayed symptoms as described above. It is not as common and usually it is one or the other.
What to do if you are suspecting a milk allergy or any food allergy?
The most important thing is to speak with a HCP that has the right competencies and an interest in allergy. They will listen to your concerns and take an allergy focused history (lots of questions to understand if your little one’s symptoms are allergy related or not). From there, they will decide management and whether allergy tests are required (I will go into lots more detail on allergy tests on another blog!)
It’s important to get a timely diagnosis and sadly this isn’t always the case, with the average time to get a diagnosis taking 4 months in the UK. A survey by Allergy UK found that the 15% waiting more than 3 months visited their GP 10 times before a diagnosis.
If you are struggling to know if your little ones symptoms are allergy related, then reach out, I provide further support in my 1:1 appointments where I will conduct an allergy focused history as well as ensuring your bub is getting everything they need nutritionally to support their growth.