For infants with a suspected or proven allergy to cow’s milk, breastfeeding is mostly recommended. In some individual, severe, cases, it’s even recommended that the lactating mother follows a dairy free diet. Because traces of the allergen can pass through the mothers milk to the child. It should be noted that this is not a general rule, but it must be considered on an individual basis.
Weaning should be started at a later stage than it would be done in normal circumstances, after 6 months. When started, it should be carried out with the utmost care; only one food at a time should be introduced and these should not contain any cow’s milk. Furthermore, it’s very important to examine the food labels very carefully because many foods contain cow’s milk proteins.
The following should be avoided: whey, curd, casein, butter, butter-milk, caseinate, lactalbumin, lactoglobulin and lactose. This is not necessarily the case for products, which contain lactate or lactic acid.
It’s also possible that traces of cow’s milk protein can be present in some non-foods such as medicines, toothpastes and vitamin preparations. Seek advice from your pharmacist.
In cow's milk allergy, even minimal quantities can cause allergy symptoms (1).
- More than 30 different protein types in cow’s milk can result in the production of antibodies
- 80% of those allergic to cow's milk can use soya based drinks.
In a study by Zeiger the prevalence of soya allergy was determined in cases of Ig-E associated cow's milk allergy. Only 14% of the children were found to have a soya allergy (2,3). These children with confirmed soya allergy are recommended to use hydrolyzed milk formulas, where the proteins are completely split, and thus cannot cause any allergic reactions. Some pediatricians recommend, as a precaution, to give preference to these formules for infants with cow’s milk allergy, although these formulas tend to be more expensive and less palatable than soyamilk.
There are also known cases where partially hydrolyzed milk still contains traces of milk protein, which can cause allergic reactions.
An Australian panel of pediatricians (4) reached a consensus in 2008 that soy formula can be recommended as first choice for infants over 6 months of age with immediate food reactions to cow’s milk, and for those with gastrointestinal symptoms or atopic dermatitis related to cow’s milk protein allergy. A task force of European pediatricians developed in 2007 guidelines for the management of cow's milk protein allergy in infants (5). Breastfeeding should be promoted for the primary prevention of allergy. Although soy formulations are significantly cheaper and have a better acceptance than extensively hydrolyzed formulae and amino acid-based formulae, the risk that the child will develop soy allergy in addition to cow’s milk protein allergy, particularly in infants below 6 months of age, was considered by the authors to be too high for it to be recommended as the first choice. Soy may be considered in infants refusing to drink extensively hydrolyzed formulae and/or amino acid-based formulae, especially beyond the age of 6 months (5).
Soyamilk is still, for a majority of these children, a viable choice. For children younger then 1 year an infant formula for babies should be chosen, which is adjusted to the needs of the infant. Older children can use the regular, but calcium-enriched soyamilk products as part of the diet (6).
References
- Laoprasert et al. Anaphylaxis in a milk-allergic child following ingestion of lemon sorbet containing trace quantities of milk. J Food Prot 1998 Nov; 61(11): 1522-4.
- Zeiger. Soy allergy in infants and children with IgE-associated cow's milk allergy. J Pediatr. 1999; 134(5): 614-622.
- Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003; 111(6).
- Kemp AS, Hill DJ, Allen KJ et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust 2008;188:109-12.
- Vandenplas Y, Brueton M, Dupont C et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 2007;92:902-8.
- Businco L, Bruno G, Giampietro PG. Soy-protein for the prevention and treatment of children with cow’s milk allergy. Am J Clin Nutr 1998(suppl); 1477S-52S.