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This website is about the management of cows’ milk protein allergy and nutritional solutions intended for infants. By continuing on this website, you accept that Nestlé Health Science supplies the information at your own request.


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Key facts about cows' milk allergy (CMA)

Food allergy or non-allergic food hypersensitivity

Top 8 food allergens

Non-allergic food hypersensitivities, such as intolerances, result from the inability to digest certain components of foods i.e. lactose or fructose. Non-allergic food hypersensitivities do not involve the immune system.1

 

Food allergies arise through an immunological reaction to certain allergens in food. These allergens are almost always proteins.2 Other components in food, such as lactose and other carbohydrates, do not commonly act as allergens.

 

Certain allergens cause more reactions than others. In no particular order, here are the eight most common allergens accounting for approximately 90 percent of all allergic reactions to food in children.3

 

Food allergy is an increasing health concern in infants and young children.4

Cows' milk allergy

CMA is one of the most common food allergies in the first year of life. It occurs when an infant’s immune system reacts abnormally to the proteins in cows' milk, which are either transferred from the mother while breastfeeding or from cows' milk protein-containing formulas and complementary food. The immune reaction may be immunoglobulin (Ig)E-mediated, non-IgE-mediated, or mixed. The reactions can be immediate (early) reactions, occurring from minutes to hours after exposure, and/or delayed (late) reactions, which can manifest 48 hours or even a week following ingestion. Immediate reactions are more likely to involve IgE, but combinations of immediate and delayed reactions can occur in some infants.4

Lactose intolerance

Lactose intolerance results from a decreased ability to digest and absorb lactose (the sugar present in mammalian milk) due to a lack of the enzyme lactase. It is very rare in infants younger than 5 years5, even in those with CMA. Breast milk naturally contains a high amount of lactose, which is beneficial for healthy infant growth and development.6

CMA Prevelance

Lactose Intolerance Prevelance

3% of infants ≤1 year 2,7

As a key component of human breastmilk, it is very rare in children ≤5 years5

65% of people globally have lactose intolerance in adulthood8

Importance of lactose for gut microbiota

Lactose is a disaccharide comprising glucose and galactose.5 As a key component of breast milk, lactose is important for healthy growth and development, providing energy and supporting the absorption of calcium15. Lactose inhibits putrefactive bacteria and promotes the development of healthy gut microbiota.9 Therefore, it is not recomended that lactose is eliminated from the infant’s diet.

 

In specialist infant formulas, lactose also has another important benefit: it improves their taste. The pleasant taste and aroma of lactose contribute toward improved acceptance of extensively hydrolysed formulas (eHFs) intended for the management of CMA in infants.10 This reinforces the importance of lactose in the infant’s diet.

Incidence and prevalence of CMA
% of infants outgrowing CMPA from 1 year onwards

Prospective cohort studies in Europe suggest a 10-year prevalence of 1.9% to 4.9% for CMA in infancy.11 The results of a meta-analysis of 229 articles published between 1967 and 2001 support this, with incidence rates of CMA shown to be between 2% and 3% in infants less than 1 year old.7

The majority of children outgrow CMA: 60–77% children outgrow CMA by 2 years, this increases to 84–87% before the age of 3.7



Signs & Symptoms of cows' milk allergy
The non-specific signs and symptoms of CMA, ranging from colic and reflux to constipation, insomnia, eczema, diarrhoea and crying, make diagnosis a real challenge. The symptoms involve many different organ systems, predominantly the skin and the gastrointestinal and respiratory tracts. The involvement of two or more organ systems increases the likelihood of CMA.
Digestive symptoms of cow’s milk protein allergy

Digestive

 




Prevalence of digestive symptoms

Up to 60% of affected infants have digestive symptoms.7

Respiratory symptoms of cow’s milk protein allergy

Respiratory

 











Prevalence of respiratory symptoms

Up to 30% of affected infants have respiratory symptoms.7

Skin-related symptoms of cow’s milk protein allergy

Skin

 












Prevalence of skin-related symptoms

Up to 70% of affected infants have skin-related symptoms.7

General symptoms of cow’s milk protein allergy

General

 











Inconsolable crying is common in infants with CMA, while anaphylaxis is rare.

Diagnosis of CMA should always be made by a healthcare professional


REFERENCES

  1. NICE. Food allergy in under 19s: assessment and diagnosis. CG116. 2011.
  2. NHS Choices. Food Allergy.2016 Available at: https://www.nhs.uk/conditions/food-allergy/ (Accessed November 2017).
  3. US FDA. Food Allergies: What You Need to Know. Available at: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm079311.htm (accessed Jan 2017).
  4. Koletzko S et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN Gl Committee Practical Guidelines. JPGN. 2012;55:221–9.
  5. Heyman MB et al. Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118(3):1279–86.
  6. Martin C et al. Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients 2016, 8, 279;
  7. Høst & Halken. Cow’s Milk Allergy: Where have we Come from and where are we Going? Endocrine, Metabolic & Immune Disorders - Drug Targets, 2014:14:2-8.
  8. NIH. Lactose intolerance. Available at: https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics (accessed February 2017).
  9. Francavilla R et al. Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy. Pediatr Allergy Immunol. 2012;23(5):420–7.
  10. Luyt D et al. BSACI Milk allergy guideline. Clinical & Experimental Allergy, 2014 (44) 642–672.
  11. Venter C et al. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy – a UK primary care practical guide. Clinical and Translational Allergy. 2013;3(1):23
  12. Koletzko S, et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN Gl Committee Practical Guidelines. JPGN. 2012;55:221–9.
  13. Lifschitz C & Szajewskav H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015;174(2):141–50;2.
  14. Høst A & Halken S. Cow's milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets. 2014;14(1):2–8.
  15. Abrams S. et al. Calcium and zinc absorption from lactose-containing and lactose free infant formulas. Am J Clin Nutr, 2002; 76:442–6.
IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cows' milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows' milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.