Milk allergy in children

What is milk allergy (cow's milk protein allergy) in children?Milk allergy is an allergic reaction to one or more of the proteins in cow's milk. A more correct name for milk allergy is therefore cow's milk protein allergy.

Usually, the child's immune system does not react to cow's milk proteins in food. In a child with a milk allergy, the immune system mistakenly perceives cow's milk proteins as harmful and triggers an allergic reaction. This reaction can vary in form, severity and the time it takes for symptoms to appear.

Cow's milk protein allergy is the most common food allergy in children and affects 2-3.5% of all children.
On average, children develop tolerance to cow's milk proteins between the ages of 3 and 5.
Symptoms often start a couple of weeks after the first exposure to cow's milk proteins.

There is a difference between what we call milk allergy (cow's milk protein allergy) and lactose intolerance.

Symptoms of cow's milk protein allergyThe symptoms of cow's milk protein allergy can vary and include, among other things:

Colic
Skin problems: red itchy rash, eczema or swelling of the lips, face and around the eyes.
Problems with digestion: vomiting, stomach pain or diarrhoea.
Hay fever-like symptoms: sneezing, itchy, stuffy or runny nose.
The symptoms can vary in severity and can range from mild to severe reactions.

The symptoms can either appear immediately (within minutes or a few hours) after the consumption of food containing cow's milk proteins, or it can take several days for the symptoms to develop.

Several of these symptoms can also be caused by other things than milk allergy. It is therefore important that the symptoms are discussed with a doctor.

The symptoms usually develop after:

Exposure to cow's milk proteins via regular infant formula.
Breastfeeding – cow's milk proteins are transferred to breast milk via the mother's diet.
Intake of cow's milk-based transitional food, i.e. when introducing solid food.

How is milk allergy diagnosed in children?

Cow's milk protein allergy is sometimes difficult to detect because of the different symptoms it causes. To be diagnosed with a milk allergy, the child must go through several different tests carried out by a doctor.

The investigation can take up to several days and months. You usually have to go to a doctor's check-up during the examination, possibly to a specialist if necessary.

Medical history of milk allergy

The investigation often starts with recording a clinical medical history with a focus on allergies, which includes, among other things, mapping of hereditary conditions, diet, symptoms and visible signs of the allergy, as well as what measures have already been tried.

Allergy testsIt may also happen that the child has to take various allergy tests in connection with the examination, such as a prick test or a blood test.

A prick test involves applying cow's milk proteins to an area of the child's skin, and then seeing if signs of an allergic reaction occur. If the child is allergic, the area will be red or swollen within 15-20 minutes. The doctor will interpret the result and see it in the context of the child's medical history and other factors.

The doctor can also take a blood sample from the child. This is analyzed to see if the child has antibodies against cow's milk proteins in the blood. If so, it may indicate that an allergic reaction to cow's milk proteins has occurred.

Elimination diet and food provocation

As part of the examination, the doctor may suggest carrying out an elimination diet followed by a dietary challenge.

Elimination diet involves removing all cow's milk proteins from the child's diet for a short period, and seeing what effect this has on the child's symptoms. Fragments of cow's milk proteins can be transferred from mother to child via breast milk, and breastfeeding mothers may therefore be asked to remove all cow's milk products from their own diet.

If the child receives regular formula, an elimination diet means that the child switches to a hypoallergenic formula (special nutrition) recommended by the doctor. Hypoallergenic breast milk substitutes are specially prepared so as not to cause allergic reactions in children with a milk allergy. The doctor will decide how and how long an elimination diet should last, usually you first have a trial period of 2-4 weeks.

If the child's symptoms have clearly improved after a few weeks of a diet without cow's milk protein, the doctor may recommend that a so-called dietary challenge be carried out. This involves giving the child a very small amount of a cow's milk-based product and watching closely for signs of allergic reactions. This can either take place at the doctor's office or in a hospital. The doctor may also ask you to gradually give the child a regular cow's milk-based formula at home, while recording any reactions. You should only start giving your child food made with cow's milk after consulting a healthcare professional.

If the child does not have an allergic reaction in connection with the food challenge or afterwards, the doctor will look for other possible causes of the child's symptoms, such as colic or lactose intolerance.

It is important that these tests are carried out by a doctor.

If your child has been diagnosed with a milk allergy, it may be useful to familiarize yourself with what it is like to live with a milk allergy and how this can be handled in everyday life, in order to be able to look after your child in the best possible way. Read more about milk allergy here.

Dietary treatment for milk allergy

Treatment is important to manage the symptoms and ensure that the diet promotes satisfactory growth and development. In European and Norwegian guidelines, it is recommended to start with a so-called highly hydrolysed special food (breast milk substitute) with a documented effect in the dietary treatment of cow's milk protein allergy in children who are not breastfed.

What is a highly hydrolysed specialty food?Cow's milk or regular infant formulas contain whole proteins. "Highly hydrolysed" means that the proteins have been broken down into small fragments, so that the immune system of most infants with a milk allergy no longer perceives these as harmful. "Hypoallergenic" means that the product is specially manufactured so as not to cause allergic reactions in most children with a milk allergy.

Source: The article was written in collaboration with the supplier.