Asthma and diet: What to eat and avoid
Cow's Milk Allergy In Babies: Everything You Need To Know
An allergic reaction in your baby will make most mums panic – especially if you think it's to do with feeding. While they aren't incredibly common, around six to eight per cent of kids under the age of three have a food allergy, and dairy is the most common type.
The good news? A cow's milk allergy is manageable and your baby may even grow out of it by the time they go to school.
If you're concerned about your little one, Specialist Paediatric Dietitian and co-founder of Mini Tummies, Elise Roberts RD has shared the key signs and symptoms of a cow's milk allergy in babies – and what you can do about it.
What is a cow's milk allergy?Cow's milk allergy (now named cow's milk protein allergy or "CMPA" for short) is an allergy to the proteins found in cow's milk. This typically happens within the first year of a baby's life.
When a child has CMPA, their immune system mistakes the protein in cow's milk for a potential threat, so it tries to fight them off and responds by releasing chemicals that cause allergic reactions.
What are the two types?There are two types of CMPA: the first is known as "Immediate onset" (IgE-mediated) and the second is "delayed onset" (non-IgE-mediated).
Both types involve an immune system response to cow's milk protein, but the exact way the immune system is involved is what separates the two. They can be described as 'immediate' and 'delayed' because of the timings for symptoms showing up.
In immediate onset CMPA, the immune system produces a specific allergy antibody called IgE, and the reactions usually show up within minutes but can take up to two hours, after consuming cow's milk.
Delayed onset allergy is more common and the symptoms can appear between 2 - 72 hours after consuming cow's milk. If the cow's milk protein is a regular part of the diet, these symptoms can become constant.
© Provided by Mother and Baby baby having milk Cow's milk allergy symptoms in babies CMPA is notoriously difficult to diagnose because many of the key symptoms are also common things most babies experience at some point for a number of reasons, for example, diarrhoea, wind, tummy pain and crying. So it's super important to work with a GP or paediatric dietitian for a diagnosis.
The common symptoms include:
• Digestive symptoms: vomiting, diarrhoea, stomach pain, constipation and reflux, and mucus or blood in their poo
• Skin symptoms: itching, unexplained rashes, worsening of any existing skin conditions like baby eczema after your baby has cow's milk.
• Respiratory symptoms: difficulty breathing, stuffy nose, wheezing, coughing
• General symptoms: particularly for the delayed onset type, you may see colic-like symptoms and irritability
In severe cases, although it's rare, immediate onset CMPA can cause a life-threatening reaction called anaphylaxis, which would show symptoms of difficulty breathing, swelling of the face or throat, a racing heartbeat, or unusual sleepiness and unconsciousness.
If you spot any of these more serious symptoms, it's really important to get urgent medical attention, so call an ambulance immediately.
Are cow's milk allergies common in babies?CMPA is one of the most common food allergies in infants and it's estimated to affect around 2% to 7% of babies under the age of 1. Although the exact numbers aren't totally clear, particularly as it's tricky to diagnose.
It can happen in both breastfed and formula-fed babies, however, it's a little more common in babies that are formula-fed, as cow's milk is a common ingredient in many types of infant formula.
The good news is that most children will grow out of their CMPA by the time they're around 18 months to 3 years old.
© Provided by Mother and Baby null When should I take my baby to a doctor? Speak to your GP, health visitor or a paediatric dietitian as soon as you start to suspect that your baby may be having an allergic reaction to cow's milk. Trying to navigate it alone can be very difficult and it's important to get an accurate diagnosis.
For your appointment, make a note of the symptoms you think they're experiencing, along with when they started, how long they tend to last and when they appear after they have cow's milk. It can also be helpful to take photographs of any visible symptoms if you can.
How is a milk allergy diagnosed?A cow's milk allergy is typically diagnosed through a combination of taking medical history, physical examination and allergy testing, however, this differs slightly depending on the type of CMPA your baby is suspected of having (whether it's immediate or delayed).
First, you'll be asked about your baby's symptoms in detail, what they had to eat or drink, and other health conditions, as well as whether there was anything else happening around the same time as the symptoms started. Perhaps they started weaning or you introduced formula milk for the first time? This is where making note of the timings is really helpful, so your GP or dietitian can get a clear picture and accurately assess the symptoms.
For immediate-type allergies, you'll often be referred to an allergy specialist for further testing. The two main tests are:
• A skin prick test, where a small amount of milk protein is dropped onto baby's skin and the visible reaction is measured
• A specific blood test, which can only be offered by specialist allergy doctors.
While there might be some at-home tests online claiming to identify allergies and intolerances, please don't waste your money on these. Online allergy tests should be avoided at all costs - at best, they're not particularly useful, and at worst, they can be misleading. As a worried parent, you deserve the best science-backed support!
For delayed-type reactions, the diagnosis is a little trickier as there's currently no blood or skin test that can confirm or rule out this type of allergy.
Instead, identifying a delayed allergy is done by excluding and then reintroducing cow's milk, while closely monitoring the effect this has on your baby's symptoms. If symptoms get better when cows milk is excluded and then come back when it's reintroduced, then a delayed onset (non-IgE) allergy diagnosis will be confirmed.
The reintroduction stage can be difficult, especially if you've seen a huge change in how well your baby feels when cow's milk is excluded. BUT, it's a crucial step in the treatment process and reduces the risk that you might be excluding cow's milk unnecessarily.
What is the treatment?Initially, the treatment is complete exclusion of cow's milk and any foods containing cow's milk protein, including dairy products like cheese and yoghurt.
If your baby is formula-fed and under 12 months old, you may be prescribed a special hypoallergenic formula, where the cow's milk protein is already broken down to make digestion easier for your baby.
If you're breastfeeding, you may also be advised to go milk-free, as the cow's milk proteins passing from you to your baby through breast milk can sometimes cause a reaction.
For babies with delayed-type allergies, you'll be advised to exclude cow's milk for a set time period, usually around 6 to 9 months. After this, your healthcare provider will take you through how to reintroduce cow's milk in a very gradual and specific way, starting with introducing small amounts of cow's milk in forms that are more easily managed (such as in biscuits), then slowly working up to introducing whole cow's milk over a few weeks. This is called working up the "milk ladder".
For immediate-type allergies, you'll be supported by a specialist allergy team and it may involve reintroducing cow's milk in a controlled hospital environment, where a medical team can supervise. This shouldn't be done alone at home without the advice of your healthcare team, to make sure your baby is well looked after in case of any serious reactions.
How to manage a cow's milk allergyMake sure to get clear advice and steps from your GP or dietitian about your baby's own treatment plan and what symptoms you need to keep an eye out for - ask as many questions as you need to!
In the 'elimination' phase, make family and friends, as well as their nursery team where relevant, aware of your baby's diagnosis and remind them not to give your little one any food or drink containing milk. It's also worth keeping a sharp eye out for any food being shared between little friends. To make things easier, always make sure you've got some milk-free alternative snacks on hand for babies over 6 months old.
As cow's milk is often the main source of calcium for children, it's also helpful to speak to a dietitian about making sure both you and baby are meeting your calcium needs. You might be recommended to take a calcium supplement and you'll be given recommendations for calcium-containing foods to include in your meals, such as sardines, soybeans, leafy greens like kale, and fortified plant-based milks.
What is the difference between a milk allergy and lactose intolerance?The key difference is that in cow's milk protein allergy, the immune system is reacting to the protein in milk, whereas in lactose intolerance, the symptoms are caused by not being able to digest the sugar (lactose) in milk. Lactose intolerance is much less common in babies and young children.
While the symptoms of lactose intolerance can be similar and equally unpleasant, it is an intolerance, not an allergy. This means it doesn't involve a response by the immune system. Instead, lactose intolerance happens when the body doesn't produce enough of a specific enzyme (called lactase) to break down the milk sugar. When lactose isn't properly digested, it can cause symptoms such as bloating, gas, diarrhoea and tummy pain.
For lactose intolerance, the treatment is to limit or avoid food and drink containing lactose - and there are lactose-free dairy products, as well as lactase supplements available to help.
Lactose-free dairy products aren't suitable for babies with cow's milk protein allergy.
About the expertElise Roberts RD is a HCPC Registered Dietitian, a children's dietitian for the NHS, and is passionate about supporting young people through nutrition to reach their full potential. She is also the co-founder of Mini Tummies which brings you everything you need to nourish your family and raise happy, confident eaters for life.
Milk Allergy
OverviewMilk allergy is an atypical immune system response to milk and products containing milk. It's one of the most common food allergies in children. Cow's milk is the usual cause of milk allergy, but milk from sheep, goats, buffalo and other mammals also can cause a reaction.
An allergic reaction usually occurs soon after you or your child consumes milk. Signs and symptoms of milk allergy range from mild to severe and can include wheezing, vomiting, hives and digestive problems. Milk allergy can also cause anaphylaxis -- a severe, life-threatening reaction.
Avoiding milk and milk products is the primary treatment for milk allergy. Fortunately, most children outgrow milk allergy. Those who don't outgrow it may need to continue to avoid milk products.
SymptomsMilk allergy symptoms, which differ from person to person, occur a few minutes to a few hours after you or your child drinks milk or eats milk products.
Immediate signs and symptoms of milk allergy might include:
Signs and symptoms that may take more time to develop include:
A true milk allergy differs from milk protein intolerance and lactose intolerance. Unlike milk allergy, intolerance doesn't involve the immune system. Milk intolerance requires different treatment from true milk allergy.
Common signs and symptoms of milk protein intolerance or lactose intolerance include digestive problems, such as bloating, gas or diarrhea, after consuming milk or products containing milk.
AnaphylaxisMilk allergy can cause anaphylaxis, a life-threatening reaction that narrows the airways and can block breathing. Milk is the third most common food -- after peanuts and tree nuts -- to cause anaphylaxis.
If you or your child has a reaction to milk, tell your health care provider, no matter how mild the reaction. Tests can help confirm milk allergy, so you can avoid future and potentially worse reactions.
Anaphylaxis is a medical emergency and requires treatment with an epinephrine (adrenaline) shot (EpiPen, Adrenaclick, others) and a trip to the emergency room. Signs and symptoms start soon after milk consumption and can include:
See your provider or an allergist if you or your child experiences milk allergy symptoms shortly after consuming milk. If possible, see your provider during the allergic reaction to help make a diagnosis. Seek emergency treatment if you or your child develops signs or symptoms of anaphylaxis.
CausesAll true food allergies are caused by an immune system malfunction. If you have milk allergy, your immune system identifies certain milk proteins as harmful, triggering the production of immunoglobulin E (IgE) antibodies to neutralize the protein (allergen). The next time you come in contact with these proteins, IgE antibodies recognize them and signal your immune system to release histamine and other chemicals, causing a range of allergic signs and symptoms.
There are two main proteins in cow's milk that can cause an allergic reaction:
You or your child may be allergic to only one milk protein or to both. These proteins may be hard to avoid because they're also in some processed foods. And most people who react to cow's milk will react to sheep, goat and buffalo milk.
Food protein-induced enterocolitis syndrome (FPIES)A food allergen can also cause what's sometimes called a delayed food allergy. Although any food can be a trigger, milk is one of the most common. The reaction, commonly vomiting and diarrhea, usually occurs within hours after eating the trigger rather than within minutes.
Unlike some food allergies, FPIES usually resolves over time. As with milk allergy, preventing an FPIES reaction involves avoiding milk and milk products.
Risk factorsCertain factors may increase the risk of developing milk allergy:
Children who are allergic to milk are more likely to develop certain other health problems, including:
There's no sure way to prevent a food allergy, but you can prevent reactions by avoiding the food that causes them. If you know you or your child is allergic to milk, avoid milk and milk products.
Read food labels carefully. Look for casein, a milk derivative, which can be found in some unexpected places, such as in some canned tuna, sausage or nondairy products. Question ingredients when ordering in restaurants.
Sources of milkObvious sources of allergy-causing milk proteins are found in dairy products, including:
Milk can be harder to identify when it's used as an ingredient in processed foods, including baked goods and processed meats. Hidden sources of milk include:
Even if a food is labeled "milk-free" or "nondairy," it may contain allergy-causing milk proteins -- so you have to read the label carefully. When in doubt, contact the manufacturer to be sure a product doesn't contain milk ingredients.
When eating out, ask how foods have been prepared. Does your steak have melted butter on it? Was your seafood dipped in milk before cooking?
If you're at risk of a serious allergic reaction, talk with your health care provider about carrying and using emergency epinephrine (adrenaline). If you have already had a severe reaction, wear a medical alert bracelet or necklace that lets others know you have a food allergy.
Milk alternatives for infantsIn children who are allergic to milk, breastfeeding and the use of hypoallergenic formula can prevent allergic reactions.
Hypoallergenic formulas are produced by using enzymes to break down (hydrolyze) milk proteins, such as casein or whey. Further processing can include heat and filtering. Depending on their level of processing, products are classified as either partially or extensively hydrolyzed. Or they may also be called elemental formulas.
Some hypoallergenic formulas aren't milk based, but instead contain amino acids. Besides extensively hydrolyzed products, amino-acid-based formulas are the least likely to cause an allergic reaction.
If you're breastfeeding and your child is allergic to milk, cow's milk proteins passed through your breast milk may cause an allergic reaction. You may need to exclude from your diet all products that contain milk. Talk to your health care provider if you know -- or suspect -- that your child has milk allergy and develops allergy signs and symptoms after breastfeeding.
If you or your child is on a milk-free diet, your health care provider or dietitian can help you plan nutritionally balanced meals. You or your child may need to take supplements to replace calcium and nutrients found in milk, such as vitamin D and riboflavin.
DiagnosisWhen food causes an allergic reaction, it isn't always easy to find out what food is to blame. To evaluate whether you or your child has milk allergy, your health care provider may:
He or she may also recommend one or both of the following tests:
If your examination and test results can't confirm milk allergy, your health care provider might administer an oral challenge, in which you are fed different foods that may or may not contain milk in increasing amounts to see if you react to the ones that contain milk. It's a good idea to have allergy tests administered by an allergist who's been trained to manage serious reactions.
If your provider suspects that your symptoms are caused by something other than a food allergy, you may need other tests to identify -- or rule out -- other medical problems.
TreatmentThe only way to prevent an allergic reaction is to avoid milk and milk proteins. This can be difficult because milk is a common ingredient in many foods. Also, some people with milk allergy can tolerate milk in some forms, such as milk that's heated in baked goods, or in some processed foods, such as yogurt. Talk to your health care provider about what to avoid.
If you or your child has a serious allergic reaction (anaphylaxis), you may need an emergency injection of epinephrine (adrenaline) and a trip to the emergency room. If you're at risk of having a severe reaction, you or your child may need to carry injectable epinephrine (EpiPen, Adrenaclick, others) at all times. Have your provider or pharmacist demonstrate how to use this device so that you're prepared for an emergency.
Coping and supportHaving a serious allergy or being the parent of a child with a potentially life-threatening allergy can be stressful. Talking to others in similar situations can be helpful. Besides offering support and encouragement, they may also provide useful coping tips, such as how to deal effectively with school officials to ensure your child's medical needs are met. Ask your health care provider if there are any support groups in your area, or contact the Asthma and Allergy Foundation of America.
Preparing for an appointmentYou're likely to start by seeing your family health care provider or your child's pediatrician. However, you may then be referred to a doctor who specializes in allergic disorders (allergist-immunologist).
Here's some information to help you get ready for your appointment and to know what to expect.
What you can doPreparing a list of questions can help you make the most of your time with your provider. For milk allergy, some basic questions to ask include:
Don't hesitate to ask any other questions you may have.
What to expect from your doctorYour provider is likely to ask you a number of questions, including:
If you're having mild allergy symptoms from eating something that contained milk, taking an antihistamine medication may lessen your discomfort. Watch for more-severe symptoms that might require medical attention. If you or your child has symptoms of anaphylaxis, seek emergency medical care.
©2022 Mayo Foundation for Medical Education and Research (MRMER). All rights reserved.
Feeding Baby: How To Avoid Food Allergies
Starting to feed a baby solid foods is an exciting milestone for parents. However, it comes with a lot of questions and concerns, especially about food allergies. What foods are most likely to cause allergies in babies? How do you avoid them?
Emerging research has shown that introducing multiple foods together is safe, and may help the immune system have a lower risk of developing food allergies, but more studies are needed. Check with your doctor for what's best for your baby.
It's most important to introduce a baby to new foods gradually, one at a time, in case of food allergies. If not, a parent may have trouble tying an allergy to a specific new food. For example, if you give your baby three new foods over the course of a day and they develop an allergic reaction, you won't know which of the foods provoked it.
The type of food or the order in which food is introduced is not much of a concern, as long as the foods you are offering are healthy and well-balanced for the baby. Each time you offer a new food, you should wait three to five days before adding another new item to the menu. Don't eliminate the other foods your baby is eating during that time; you already know these are safe because the child has not had any food reactions up until now. Just don't add anything else new.
With any new food, you'll want to be on the lookout for any allergic reactions. There are more than 160 allergenic foods; certain foods may be more allergenic than others. The following eight foods and food groups are known to possibly cause problems with allergic reactions possibly up to 90% of the time.
New nutrition guidelines from the American Academy of Pediatrics say it's okay to introduce these allergy-causing foods when your baby is ready to eat solids. There is no evidence that waiting until the baby is older prevents food allergy. If you believe your baby has an allergic reaction to a food, such as diarrhea, rash, or vomiting, talk with your child's doctor about the best choices for the diet.
Within a few months of starting solid foods, your baby's daily diet should include a variety of foods, such as breast milk, formula, or both; meats; cereal; vegetables; fruits; eggs; and fish.
Food allergy symptoms usually appear very soon after the food is eaten -- within a few minutes to a couple of hours. If you're introducing a new food to your baby, keep an eye out for these symptoms:
Severe allergic reactions can be fatal very quickly. If your baby is having trouble breathing/wheezing, has swelling on their face/lips, or develops severe vomiting or diarrhea after eating, immediately call 911. You can inform your pediatrician at a later time.
If you see mild symptoms, such as hives or a rash, contact your pediatrician for further evaluation. The doctor might refer you to an allergist (allergy specialist doctor), who will ask more questions and do a physical exam. The allergies may order diagnostic tests such as:
Remember, just because a baby's initial allergic reaction to a new food may be mild, it may get worse upon following exposures. Talk to your pediatrician about any food allergy symptoms in your baby.
Some allergies go away with time. Egg and milk allergies often go away as children get older, but peanut, tree nut, and shellfish allergies tend to persist. That said, research shows that in the case of peanut allergies, peanut immunotherapy drops administered under the tongue are safe and effective as treatment for peanut allergy, even in children as young as 1. They were also found to help significantly desensitize the patients to peanuts.
If there is a family food allergies, your baby has an increased risk of also developing allergies, although it is not a certainty. If you have the allergies, the odds are 50-50 for them to have them as well.
It's best to introduce the 8 allergens gradually, at one-to-two week intervals over time so that you can recognize if an allergy develops.
In a reversal of earlier policy, the American Academy of Pediatrics is now recommending that potential allergens be introduced to your infant earlier rather than later. In doing so, the move may actually help prevent them from developing allergies to those foods.
Breastfeeding you baby for 4-6 months is the best way to prevent a milk allergy. Remember that breast milk or formula is higher in nutrition. When you begin to introduce whole milk, you should do so under a doctor's supervision. Yogurt and soft cheeses are fine, because the proteins in these dairy products are broken down and less likely to cause tummy trouble.
The AAP now advises that, in the case of infants who are at high risk of allergies, peanuts should be introduced between 4-6 months. Infants at highest risk of developing peanut allergies are those with eczema or egg allergies or both. It was originally believed that introducing your baby to the foods when they are older might make any reactions more manageable.
Other potential allergens such as tree nuts and fish should be introduced over a period of time as you introduce your baby to solid foods, between 6 and 9 months
You should wait until at least age 1 (some experts say age 2) to introduce honey, which can cause a potentially serious disease called infant botulism. Ask your pediatrician for guidance.
Comments
Post a Comment