Cow's milk allergy - An allergy that manifests itself in various complaints.
An allergy is a hypersensitivity reaction of the body. Changes occur in one or more systems of the body. Skin complaints, nasal mucous reactions (hay fever), diarrhea, trachea and bronchial mucosal reactions, migraine and high blood pressure. A cause must arise for the occurrence of these symptoms.
Most common allergy
In babies, cow's milk allergy is the most common form of allergy (2 - 6% of all babies). His body reacts to the protein that is present in the milk. At the age of four, 33 to 44% of children are still intolerant of cow's milk. The allergy can disappear spontaneously over the years, your child can use cow's milk again without getting complaints.
Allergies (and therefore cow's milk allergy) often turn out to be hereditary. If you have a form of allergy yourself, chances are that your baby will also have an allergy.
What in cow's milk allergy?
This allergy can manifest itself in various complaints. Usually the complaints start in the first three months. The main symptoms are gastrointestinal complaints (50%), eczema in the face and / or cheeks (35%), airways (15%).
The complaints can be:
|Skin||itching, rash, eczema, hives (hives, urticaria), edema|
|Airways||asthma, bronchitis, nose / eye complaints|
|Gastrointestinal system||vomiting, diarrhea, constipation, colic, abdominal pain, nausea, little eating / drinking|
|Other complaints||a lot of crying, growth retardation, behavioral complaints, migraine|
The symptoms can occur within a few minutes after using the food, but also only after one or two days.
Cause cow's milk allergy?
Digestion starts in your mouth and ends in your gut. The proteins from the cow's milk are normally broken down by enzymes in the gastrointestinal tract into smaller and smaller chunks. Only very small pieces can be absorbed into the blood through the intestinal wall, so that they can be transported to all the cells in our body, where they are used as building blocks. The intestinal wall is actually a very fine filter. With a baby, the intestine is not fully mature and therefore does not work optimally.
The holes in this 'filter' are still too large. As a result, it is also possible that larger intestines (not yet fully digested) pass the intestinal wall into the blood. With most children, this can not do any harm, but in children who are allergic, the body 'sees' these proteins as 'unsafe substances', causing the immune system to take effect. (As with bacteria and viruses).
Antibodies are created by this immune system. These substances attach themselves to special cells (mast cells) that contain certain irritants (histamine). The mast cells are found everywhere in the body, especially in the skin and in the mucous membranes of the airways and the gastrointestinal tract. As soon as the mast cell comes into contact with such a (not fully digested) protein for the second time, the mast cell will be destroyed. This will release the histamine and cause allergic symptoms.
Which investigations are possible?
With these complaints it is advisable to discuss this with the general practitioner or the consultation office doctor and to find out whether it is a cow's milk allergy. In order to arrive at the correct diagnosis, they have made agreements about how to deal with possible food allergies. These agreements have been recorded by the consultation office doctors in a kind of step-by-step plan: 'The national standard for the diagnosis and treatment of food allergy in infants at the clinic'. The general practitioners also have such a 'standard'.
In general, research into cow's milk allergy can consist of:
- questions about the occurrence of allergic diseases in your family (family history), about the daily diet (nutritional history) and about the history of the disease (history);
- physical examination, depending on the complaints;
- a blood and / or skin test;
- elimination provocation test.
Source: Stichting VoedselAllergie.
Treatment of cow's milk allergy
A cow's milk allergy treatment is based on the omission of cow's milk proteins from the diet.
If you are breastfeeding, you will have to leave all dairy products yourself (dairy products include milk, yoghurt and cheese), but also all products that contain milk. Breastfeeding, where the mother keeps a diet, is still the best food for the allergic baby.
Only breastfeeding contains antibodies (immunoglobulins) that give the baby extra protection against pathogens. Give breastfeeding for at least six months without supplementation. If you give your baby formula, you can switch to an infant formula based on protein hydrolyzate. Partial hydrolysates are not suitable as food for proven cow's milk allergy. It is advised to refrain from supplementing for the first six months. At an earlier start, there is a greater chance of developing a food allergy.
Sometimes not all complaints can be prevented - despite a diet - and additional medication is needed to reduce the symptoms.
To prevent the allergic symptoms from continuing, a correct and consistent diet is the only solution for cow's milk allergy. In addition, special dietary measures may be necessary for infants to prevent other food allergies.
Sometimes not all complaints can be prevented - despite dieting - and additional medication is needed to reduce the symptoms. More information on this can be found in the general information brochure of the Food Allergy Foundation.
Cow's milk allergy always requires treatment by a doctor or specialist. Also consult a dietitian for guidance in following the diet and to keep an eye on the completeness of the overall diet.
Dietary measures for infants
- breastfeeding, where the mother follows a hypoallergenic diet is preferred;
- hypoallergenic infant formula, if breastfeeding is not desired or not possible;
- supplementary feeding (vegetable and fruit juice) start from 4 months and slowly expand;
- introduction of strong allergens (milk, egg, soy, wheat, peanuts, nuts, fish, crustaceans and shellfish, seeds and seeds) after consultation with the treating physician and dietitian. For egg, peanut and crustaceans it is recommended to give it only after the second birthday.
Breastfeeding, where the mother follows a hypoallergenic diet
An infant can develop cow's milk allergy despite breastfeeding the baby. In breastfeeding, small amounts of proteins can occur from the mother's diet, for example cow's milk protein. These small amounts are sometimes able to cause an allergy to the baby because the immune system will make specific antibodies against the cow's milk protein (see above). When the baby comes in contact with these small pieces of cow's milk protein, complaints occur. This can also happen during lactation, but sometimes the first reaction only occurs when the child starts bottle-feeding.
Why still breastfeed?
Breastfeeding, where the mother keeps a diet, is still the best food for the allergic baby. Only breastfeeding contains antibodies (immunoglobulins) that give the baby extra protection against pathogens. These antibodies also help the baby's immune system and the still very fragile gastrointestinal tract to develop further. This reduces the chance of developing other allergies. The baby can not or hardly make these protective antibodies themselves for the first six months. That is why it is very important to exclusively breastfeed for four months. These antibodies are not in bottle feeding.
Nutrition is only given after four months according to a special ascension schedule and under the guidance of a dietitian. The gastrointestinal tract of the baby will get the chance to recover and develop further. In this way one tries to prevent the child from reacting to other foods such as the fruit or vegetable juice.
The mother's diet during the examination
First of all, cow's milk must be omitted from the mother's diet, since the baby reacts with complaints. In addition, during the period in which the child is allergic, the mother should not take any foods known to be highly allergenic such as chicken egg, peanuts, nuts, seeds, seeds, soy, fish, crustaceans and shellfish. These dietary advice should take place under the guidance of a dietitian. Often additional minerals and vitamins are necessary for the mother in such a diet. The dietitian can then also advise on this.
Cow's milk and chicken egg
Cow's milk and chicken egg are processed in so many foods that it is not enough to avoid them in pure, recognizable form. Foods in which cow's milk or chicken egg is processed are also removed from the diet. Peanut is a very strong allergen and for that reason it is to be considered to omit it completely from the diet.
For nuts, seeds, seeds, soy, fish, crustaceans and shellfish, it is sufficient to avoid only the pure, recognizable form. Eat further as varied as possible.
The mother's diet after cow's milk allergy has been established in the infant
In consultation with the treating physician and dietitian, the mother can decide, from a preventive point of view, to continue the diet during the breastfeeding period, thus trying to prevent other food allergies from developing in the baby (see brochure -Prevention-);
Depending on the personal situation, the mother can also decide not to take a preventive diet. Once it is certain that the child is allergic (usually that cow's milk protein), the other products can return to the food one by one. However, it is wise to also omit egg from the diet.
Hypoallergenic infant formula
The current infant formula is not suitable for babies with cow's milk allergy because they contain complete cow's milk protein. The doctor will advise a hypoallergenic milk substitute suitable for infants. Even if the baby is receiving hypoallergenic infant nutrition, it is only after 4 months that supplementation is started.
What is a hypoallergenic milk replacer?
In hypoallergenic milk substitutes, the (cow's milk) proteins have been hydrolyzed (pre-digested). They are cut into small pieces, as it were, so that the immune system does not recognize them as cow's milk protein fragments and therefore does not produce specific antibodies. The mast cells will not react and as a result no allergic symptoms will occur.
Which hypoallergenic milk replacers are there?
- partial hydrolyzate (partly pre-digested, intended for prevention, not suitable for treatment);
- strong hydrolyzate based on whey protein;
- strong hydrolyzate based on casein;
- loose components (free amino acids, the smallest possible protein fragments).
If the doctor thinks your child has cow's milk allergy, he will advise to switch to highly hydrolysed infant formula. Usually a diet is started where the protein chunks are derived from whey proteins. Often a whey protein hydrolyzate is sufficient, but sometimes not.
If the symptoms do not decrease, it could be that the transition to a casein-based hydrolyzate only improves. Virtually every allergic child tolerates this hypoallergenic infant formula perfectly.
If no result is achieved and the suspicion of (severe) cow's milk allergy persists, an amino acid mixture is used today.
Only when this diet does not give a result, the diagnosis of cow's milk allergy can definitely be ruled out.
Hypoallergenic suction feeding
Hypoallergenic infant formula based on free amino acids (an amino acid mixture of individual components) appears to be needed only once. There are almost always more complex allergies than 'only' cow's milk allergy and often there are serious intestinal complaints. Specialized help from a pediatrician or allergist is always necessary.
In case of severe atopic eczema, a strong hydrolyzate based on casein is often immediately given.
A diet must be tried for at least four weeks before conclusions can be drawn to it; changing food quickly is extra stressful, especially for children with a sensitive gastrointestinal tract. It is also important that the cow's milk allergy is proven, if the complaints allow it, by (if the hypoallergenic milk substitute is successful) to give the old diet a short time again (elimination provocation test).
If your child regains the same symptoms, it is certain that they are caused by cow's milk allergy.
The use of hypoallergenic milk replacers in practice
All hypoallergenic milk replacers taste bitter. This is due to the pre-conversion of the proteins. Remember, however, that we adults have a very different taste experience than infants. You can let every child get used to a new taste. If necessary, start with small amounts (first replace a scoop, build up step by step until the food is completely replaced by hypoallergenic milk substitute). Give the food, in connection with the smell, in a bottle or closed (tumble) cup. In older children, a closed cup with a straw can help.
Reimbursement of hypoallergenic milk replacements
With proven cow's milk allergy, the costs of hypoallergenic milk replacements for children up to and including the age of two and a half years are reimbursed. The doctor must first request an authorization from the health insurer. The cow's milk allergy must be proven by means of an elimination provocation test. Only in exceptional cases will this be deviated from.
Dietary measures for older children and adults
- avoid using cow's milk and foods that contain cow's milk; make use of a dietary list of your dietitian and a branded item list;
- use a hypoallergenic milk substitute (as described above), suitable for older children and adults or a supplement of vitamins and minerals, on the advice of the doctor and under the supervision of a dietitian;
- soya, which is also an allergen product, can often be given as a milk substitute in the form of special soy milk from the age of one to two years in many (but not all) children and adults. This is because the gastrointestinal system is now less vulnerable;
- eat as varied as possible, to try to prevent the development of other food allergies as much as possible.
Soy milk and goat milk
In the past, a diet based on soy milk was prescribed for cow's milk allergy. One has come back to this, because many children with cow's milk allergy can also develop allergy to soy. Soy is a strong allergen and soy allergy is often more persistent than allergy to cow's milk. Goat milk based nutrition is not an alternative, because the goat milk proteins have such a similar structure to cow's milk that allergies to cow's milk also cause allergic symptoms when using goat's milk. In addition, the infant formula is not fully fledged in a cow's milk-free diet, using ordinary goat's milk.
- If your child uses a hypo-allergenic diet, the stool often becomes thinner and green.
- Inform grandfathers and grandmothers, babysitters, school, parents of friends about your child's diet.
- Give your emergency telephone number and that of yourself at school or crèche
- general practitioner.
- Let your child take the treat home first before he / she eats it.
- Put a little drum at school or the day care center with goodies that your child may have, if there is a treat.
- Hang in the kitchen a list with what your child may and may not have.
- There are special books in the bookstore with recipes for a diet.
Recognize cow's milk and read labels
Products that always contain cow's milk are not permitted in a cow's milk-free diet. This applies to all following products that are usually easy to recognize:
- skimmed milk, semi-skimmed milk, whole milk, buttermilk
- cheese, cheese spread, processed cheese
- yogurt, biogarde, custard, cottage cheese, porridge, pudding, yoghurt drink
- kefir, hutskase, cottage cheese, umer
- butter, whipped cream, coffee cream, half cream, coffee milk, sour cream, sour cream, crème fraîche
- ice cream, yogurt ice cream
- dairy soft drinks, soft drinks on a basic basis
How can you recognize from the label whether a product contains cow's milk? The label then contains one of the following additions:
- milk, milk powder, (skimmed or dry) milk components
- curd, whey, whey powder and milk salt
- milk powder, skimmed milk powder, whole milk powder, milk derivative
- caseinate, casein, milk protein, hydrolyzed milk protein,
- margarine (no vegetable), butter, butter concentrate, butter oil, milk fat, milk salt
- lactose, milk sugar (often contain traces of cow's milk protein, unless it is extra refined)
- lactalbumin, beta-lactoglobulin, lactoperoxidase, lactoval, recalent, transglutaminase, nisin (E234)
- bread improvers may contain cow's milk
Confusing are the names lactic acid, lactate, cocoa butter and coconut milk. These substances have nothing to do with cow's milk.
At the food center you can find brand name lists containing all products that do not contain cow's milk. The store where you can buy it is also listed. This is very useful, so that you can search for what you want to buy at home.
Cow's milk allergy should not be confused with lactose intolerance. These are two very different disorders, although lactose (milk sugar) also occurs in cow's milk and can also cause complaints of the gastrointestinal tract (but no complaints of airways or skin).
Reaction to cow's milk allergy
In cow's milk allergy a reaction takes place on the protein in the cow's milk, in lactose intolerance these proteins are tolerated, but the lactose, the milk sugar, the cause of the complaints. Lactose must be split by the enzyme lactase, so that the fragments can be taken from the intestines in the blood.
With lactose intolerance there is a shortage of the enzyme lactase.Because the lactose can be absorbed insufficiently from the intestines in the blood, abdominal pain, flatulence or diarrhea sometimes develops after the use of (a lot of) cow's milk. Small amounts of milk products never give complaints.
Lactose intolerance in children under three years is very rare, at most short-term, for example after a viral infection of the gastrointestinal tract. At birth, each child has sufficient lactase (lactation contains even more lactose than cow's milk).