Milk protein intolerance in babies

Cow's milk protein allergy (CMPA) is an adverse immune system reaction to proteins found in cow's milk. It is more common in babies and young children, although it can also affect adults.  

The cow's milk proteins that commonly trigger the allergy are casein and whey protein (such as beta-lactoglobulin and alpha-lactalbumin). When someone with CMPA consumes foods containing these proteins, the immune system overreacts and releases chemicals like histamine, which trigger allergic symptoms.  

Understanding milk protein intolerance: signs and symptoms in babies

Babies with cow's milk protein allergy (CMPA) may show a variety of signs and symptoms that can affect different body systems. CMPA can cause a wide range of symptoms, which may vary from mild, such as hives or gastrointestinal issues, to more severe, like difficulty breathing or anaphylaxis. Some common signs and symptoms that might indicate your baby has CMPA include gastrointestinal problems such as vomiting, reflux, diarrhea, intense colic… There is also often hives, inflammation in the mouth and diaper area, nasal congestion, cough, wheezing, and it is usually accompanied by growth delay, irritability, and lack of energy. 

It is important to keep in mind that these symptoms can vary from one baby to another, and not all babies with CMPA experience all these symptoms. Additionally, these signs and symptoms can also be caused by other medical conditions, so it is essential to consult a doctor for an accurate diagnosis. 

If you suspect your baby might have cow's milk protein allergy, it is advisable to seek medical attention for a proper evaluation. A pediatrician can perform specific tests to confirm the allergy, and a nutritionist can adjust the diet or use special formulas if the baby is formula-fed. 

Management and care for babies with milk protein intolerance

The main treatment for CMPA is avoiding the consumption of dairy products containing cow's milk proteins. In breastfed babies, this often means the mother must follow a dairy-free diet. In more severe cases, the use of antihistamine medications or epinephrine may be necessary to control severe allergic reactions. 

Labeling: how to read labels with CMPA?

To avoid cow's milk protein (CMP) when reading food labels, it is important to look for ingredients that may contain dairy derivatives. Here are some tips for reading labels effectively: 

Look for keywords: Some words indicating the presence of milk proteins include: milk, whey, casein, caseinate, lactose, lactalbumin, lactoglobulin, calcium or potassium lactate, and cheese. Keep in mind that even ingredients like "natural flavor" or "vegetable protein" may contain dairy derivatives. 

Read the ingredient list carefully: Food manufacturers are required to list all ingredients on the package in descending order by quantity. If cow's milk protein is present in the product, it will be included in the ingredient list. 

Look for specific warnings: Some products may have labels clearly indicating if they contain milk or dairy products. These warnings may include phrases like "contains milk," "may contain traces of milk," or "processed in a facility that also handles milk." For example, we declare “milk-free” on those products where we guarantee the absence of milk or its traces. At this link, you can check all products filtered as suitable for CMPA.  

Be cautious with processed foods: Packaged foods may contain milk-derived ingredients that are not obvious. Carefully check the ingredient list even on foods you wouldn't expect to contain dairy. 

Milk-free breakfast and snack ideas

Oat, egg, and banana pancakes; you can use plant-based milk or water to adjust the batter's thickness. 

Whole wheat toast with hummus or avocado. 

Blueberry smoothie with almond milk and nuts. 

Soy yogurt with strawberry and banana pouch, almond milk, mango and pineapple or almond milk, cocoa, and strawberry, any of these will be perfect! 

References

Flom JD, Sicherer SH. Epidemiology of cow's milk allergy. Nutrients. 2019;11(5):1051. doi:10.3390/nu11051051.

Goldberg MR, Nachshon L, Elizur A, et al. Efficacy of baked milk oral immunotherapy in baked milk-reactive allergic patients. J Allergy Clin Immunol Pract. 2021;9(1):330-336.e3. doi:10.1016/j.jaip.2020.08.056. 

Lange L, Konstantinou GN, Forbes E, et al. Predictors of persistent cow's milk allergy in children: a retrospective cohort study. Clin Exp Allergy. 2020;50(3):316-326. doi:10.1111/cea.13534. 

Mosbech H, Lange L, Spangholm K, et al. Skin test evaluation of standardized food extracts in adults with a history of food allergy. Clin Transl Allergy. 2016;6:39. Published 2016 Sep 21. doi:10.1186/s13601-016-0132-3. 

Petrunov B, Popov G, Keranova S, et al. Cow's milk protein allergy and intolerance in infancy. Folia Med (Plovdiv). 2018;60(1):40-48. doi:10.1515/folmed-2018-0006.