Although a diagnosis of CMPA in babies will concern parents, if treated effectively most will outgrow this allergy by 2-3 years of age. CMPA is treated by the complete elimination of cow’s milk proteins in the diet.
The Children’s e-Hospital CMPA service uses a rechallenge 2-4 weeks after excluding cow’s milk protein from the diet to confirm the diagnosis. This also includes dietician supervision of your baby.
If babies are exclusively breastfed then the mother will need to follow a milk free diet, formula fed babies require a hypoallergenic formula milk which is only available on prescription. The first line treatment for formula fed infants is an extensively hydrolysed formula (eHF), which is a cow’s milk based formula that has been treated with enzymes in order to break down the proteins causing the allergy. If symptoms have not improved by two weeks then an amino acid formula may be the next line of treatment. Synthetic amino acids are used in this type of formula and as with eHF this can be less palatable than usual formula milks so the sooner they can be introduced the better in order for the baby to get used to the new milk.
Soya based formulas are not usually used as an alternative as children who are allergic to cow’s milk proteins may also be allergic to the proteins in Soya and also because of the presence of phyto-oestrogens and the use of glucose as a carbohydrate source. Although not usually suitable as a formula milk Soya can be used once weaned onto solid food as a useful alternative to yoghurts and cheese. Older children with CMPA can drink oat, almond, Soya and coconut milks but these are not suitable for children under two years of age as they are low in fats, protein and macronutrients.
Weaning a baby who is allergic to cow’s milk can be a daunting task for parents as many of the traditional first foods contain cow’s milk, however a paediatric dietician will be able to advise on alternative foods that will provide the essential nutrients. Processed foods contain many hidden cows milk products so the labels need to be checked for ingredients such as whey, lactoglobulin and casein. Children that have a cow’s milk allergy are more likely to have allergies to other foods (although they may develop no other allergies). More allergenic foods such as wheat, gluten, fish, selfish eggs, seeds, nuts, and peanuts (ground – no whole nuts should be given before 5 years of age due to choking risk) should be introduced one at a time and not before six months of age.