6 Important Signs And Causes Of Milk Allergy In Children

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Milk allergy in children occurs when a child’s immune system mistakenly perceives cow milk proteins as a threat and acts against them, triggering a reaction. A child allergic to milk develops symptoms when milk or milk-based foods are ingested. Depending on the severity of the allergic reaction, the symptoms may vary from mild to severe. Removing milk and milk products from the diet can help manage mild symptoms.

In the US, milk allergy affects about 3% of children under three years (1). Fortunately, most children outgrow milk allergies before they turn 16. Thus, prompt treatment and management of the condition are essential for managing allergic reactions.

Read this post to learn about the causes, symptoms, diagnosis, and treatment of milk allergy in children.

What Are The Causes Of Milk Allergy In Children?

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There is no exact cause of milk allergy. Genetics and environmental factors may play a role in its manifestation. Physiologically, in those with milk allergy, the body identifies milk protein as an allergen and produces IgE antibodies. These antibodies bind to allergic cells (mast cells and basophils) in the body, and release chemicals called histamines that bring symptoms of an allergic reaction (2). Each time the child consumes milk or milk products, the body displays an allergic reaction (3).

Quick fact

The body’s abnormal response to the protein found in cow’s milk is called cow’s milk protein intolerance (CMPI). A family history of CMPI or allergies may increase the risk of the child developing the condition (16).

What Are The Symptoms Of Milk Allergy In Children?

Milk allergy symptoms may appear within two hours or several hours after the milk ingestion. If you suspect your child has a milk allergy, look for the following symptoms (1).

1. Red itchy rash or skin hives
2. Swelling around the mouth, face, or around the eyes
3. Runny or blocked nose; symptoms similar to hay fever
4. Wheezing or shortness of breath and coughing
5. Vomiting, abdominal cramps, or diarrhea, blood in stool
6. Slow and poor weight gain
7. In rare cases, cow milk allergy can cause anaphylaxis. Anaphylaxis is a life-threatening immune-response that impairs breathing and leads to a state of shock.

The intensity of symptoms varies from child-to-child. Also, milk allergy symptoms often seem similar to dairy sensitivity or lactose intolerance. Therefore, if your child shows intolerance symptoms, consult a pediatrician promptly for an accurate diagnosis.

Point to consider

Milk allergy and lactose intolerance are two different phenomena. The former is an immune-system reaction, whereas the latter is a condition where the body fails to digest lactose (a sugar present in milk) (1).

How Is Milk Allergy Diagnosed In Children?

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There is no specific test that can detect cow milk allergy. Generally, the doctor will collect the family, medical, and diet history of your child along with a detailed discussion of the child’s symptoms. Based on these details, they are likely to advise the following tests (1) (4) (5).

1. Elimination test: This simple test includes eliminating milk from the diet and then reintroducing it to see if it causes a reaction. If the pediatrician suspects milk allergy, they will recommend an allergist for further evaluation to confirm the diagnosis.

2. Blood test: This test estimates the amount of total or specific immunoglobulin E (IgE) antibodies responsible for triggering an allergic reaction when a body is exposed to an allergen. However, this test does not help evaluate cow milk allergy with precision.

3. Skin prick test: In this test, a liquid containing milk or milk protein extract is placed on the forearm or the back of the hand. The skin is then pricked with a small, sterile probe, allowing the liquid to enter the skin. The development of a raised, reddish bump, within 15 to 20 minutes indicates an allergy.

4. Oral food challenge: In the test, your child will have to eat milk-based food in small but increasing quantities. If the child develops an allergy, it indicates a positive case of milk allergy. The test should only be performed in an allergist’s office with an emergency action plan ready due to its potential risk of causing a severe allergic reaction.

5. Component test: This test can help an allergist determine the specific milk protein allergen for your child. It can help accurately determine the milk component that triggered the allergy.

Based on the diagnosis, your allergist will prescribe a treatment plan consisting of different treatment modalities.

What Is The Treatment For Milk Allergy In Children?

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Milk allergy treatment aims at managing the triggers and symptoms. If your child is diagnosed with milk allergy, the treatment will include the following.

1. Remove cow’s milk and its products from your child’s diet for a while. You are likely to be referred to a pediatric nutritionist who could devise a well-balanced milk-free diet plan with healthy cow’s milk substitutes.

2. Use oral antihistamines to subside mild allergic symptoms, such as swelling, hives, runny nose, and abdominal pain.

3. Stay prepared with the use of epinephrine auto-injector in case of a severe allergic reaction. Train your child on how to use the device. Encourage them to carry the injections with them at all times.

Your child will undergo pediatric assessment every six to 12 months to know if they have outgrown the allergy.

Mary Buttler, a mother, shares her experience with her daughter’s allergy to cow’s milk protein and when she outgrew it. She says, “Allison was an extremely fussy baby. She cried ALL of the time. Since I had experience with John (her son) screaming a lot because of his cow’s milk protein allergy and I was breastfeeding again, when Allison was just two and a half weeks old, I cut out dairy. At three weeks old she had mucousy poop and at four weeks old she had blood in her diaper. At this point I had also cut out gluten, soy, and peanuts, trying to cut out any allergens I thought might be upsetting her. The doctor put her on Zantac for reflux and a few weeks later Omeprazole, but nothing was helping. She just screamed non-stop. She was eventually diagnosed with a cow’s milk protein allergy and the only thing that helped her was being put on a specialized formula… Allison grew out of the cow’s milk protein allergy by the age of one and loves her dairy products now (i).”

What To Feed To Children With Milk Allergy?

A child on a dairy-free diet may be losing essential nutrients. However, you can offer a well-balanced dairy-free diet to mitigate the risk. Below are some foods that can nutritionally substitute dairy.

1. Plant-based milk alternatives: A child may not be able to have milk due to milk allergy, but they can consume fortified soy milk, rice milk, oat milk, flax milk, almond milk, cashew milk, hemp milk, and coconut milk if they are not allergic to any of these foods.
   

2. Meat, poultry, and fish: Lean meat, poultry, and fish are excellent sources of high-quality protein and micronutrients, such as calcium, vitamin A, vitamin D, vitamin B12, iron, zinc, and potassium (6). You can offer these foods to your child as a part of a well-balanced diet.

3. Calcium-rich veggies and fruits:  Kale, amaranth, broccoli, okra, and spinach are some calcium-rich veggies that can add color, flavor, texture, and valuable nutrients to your child’s diet (7). Similarly, rhubarb, blackberries, and kiwi fruit can be healthy alternative sources of calcium that work as a substitute for dairy products (8).
   

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4. Pulses, legumes, and nuts: These foods offer protein, healthy fats, and essential micronutrients, such as iron and zinc (6). You can feed them to your child as a part of a well-balanced diet.

5. Fortified foods: Fortified foods, such as fortified cereals and health drinks, can be added to a child’s diet. You can speak to a pediatrician who can recommend a fortified cereal or health drink based on your child’s age.

Eating a well-balanced diet ensures that a child gets all the necessary nutrients in optimum amounts.

What Are The Complications Of Milk Allergy In Children?

Children with milk allergy may have a higher risk of experiencing the following complications.

• Insufficient supply of vital nutrients that can hinder the growth and development of a child. In such cases, along with a well-balanced diet, nutritional supplementation may be necessary for some time to ensure the child’s uninterrupted growth and development.

• Allergies to other foods, such as peanuts, eggs, and soy, may occur. Research shows that children with milk allergy are more likely to develop other food allergies (5). For instance, 50% of infants with cow milk allergy may also have a cross-reaction with soy protein, notes the American Academy of Pediatrics (AAP).

Poor nutrition, due to the absence of milk in the diet, can be mitigated through alternative food items. Parents of children with milk allergy should be alert to the presence of other allergies.

How To Prevent Milk Allergy In Children?

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You cannot prevent milk allergy, but allergic reactions attributed to milk allergy can be prevented by avoiding milk and milk products. Below are some steps that you should educate your child to manage milk allergy effectively (9) (10) (11).

1. Avoid all kinds of milk, such as whole, skim, low-fat, evaporated, condensed, and powdered milk.

2. Eliminate milk products, such as clarified butter, butter, butterfat, butter oil, cream, cheese, cottage cheese, yogurt, and

3. Avoid foods prepared from milk and its products, such as hot cocoa, candies, chocolates, eggnog, milkshakes, French toast, custard, ice cream, salad dressing, and pudding.

4. Check food labels carefully while buying packaged foods. The “non-dairy” label on a product means it does not contain butter, cream, or milk. But the product may have other hidden sources of milk.

5. A “lactose-free” label does not mean the product is dairy-free. Such products may still contain some milk proteins. Baked goods, such as cookies, and cereal products, such as bread and pancakes, are examples of such products.

Quick tip

Educating the child about their allergy, reading and understanding the product labels correctly, avoiding products that do not contain a label, and preparing home-cooked meals while stepping out are some ways to stay away from milk allergy (17).

6. Some processed foods or pre-cooked products may also contain milk as artificial butter flavors, such as margarine and non-dairy creamers. Luncheon meat, hot dog, and sausages contain milk as a meat binder.

7. Avoid products containing whey protein, casein, protein hydrolysates, lactose, or milk solids in their ingredient list.

8. Children allergic to cow milk may be allergic to sheep milk, goat milk, and the milk of other animals (12). In such cases, the doctor may ask your child to avoid animal milk entirely.

9. Some medicines, such as antibiotics, probiotics, and even vaccines, may contain casein, a milk protein. Inform your doctor about your child’s milk allergy before they write a prescription (13).

10. Whenever you visit a restaurant, inform the chef that you have a milk allergic visitor with you so that they avoid milk products in the food.

11. Sometimes, breast fed babies might also develop symptoms of milk allergy. In that case, doctor will advise to eliminate cow’s milk from the mother’s diet.

12. If you use Kosher foods, avoid using foods labeled with a “D” or “DE” adjacent to Kosher symbols. It indicates that the product may contain traces of milk or is manufactured on machinery that handles milk or milk products.

Infographic: Is Oral Immunotherapy Effective In Cow’s Milk Allergy?

It is difficult to completely avoid milk and dairy products as they are a part of several processed foods. Although a long-duration treatment, children with cow’s milk allergy may benefit from oral immunotherapy (OIT). The infographic below highlights the salient points of the therapy.

Illustration: Momjunction Design Team

Image: Stable Diffusion/MomJunction Design Team

Learn how to cure milk allergy and how to identify and manage its symptoms. Explore efficient treatments and lifestyle changes that can improve your overall health.

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Dr. Anuradha BansalMD

Dr. Anuradha Bansal is a highly accomplished pediatrician and neonatologist with 13 years of professional experience. Presently, she is working as Assistant Professor in the Department of Pediatrics at PIMS Jalandhar. She has done her MBBS and MD Pediatrics at GMCH, Chandigarh.

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Swati PatwalM.Sc. (Food & Nutrition), MBA

Swati Patwal is a clinical nutritionist, a Certified Diabetes Educator (CDE) and a toddler mom with more than a decade of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children.

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Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University.

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Shinta Liz SunnyM.Tech

Shinta is a biotechnologist who is highly intrigued by science and technology. She holds a master's degree in Biotechnology from Karunya Institute of Technology and Sciences and a PG Diploma in cellular and molecular diagnostics from Manipal University.

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