Bloody Stools Due to Cow's Milk Allergy

Cow's milk allergy is said to occur in 2 - 8% of infants. About 5 -15% of infants have a reaction to the cow's milk protein, but not all of these are allergic reactions. For example, lactose intolerance is not an allergy as such, but children do have a reaction to cow's milk. Read more about lactose intolerance. Allergic reactions to cow's milk may be: immediate - within minutes up to 1 hour after having cow's milk. Symptoms include hives, eczema, facial swelling, wheeze, vomiting, diarrhea. Severe reactions include anaphylaxis. These are IgE mediated reactions delayed - these can occur several hours or even days after having the milk. Symptoms include eczema, vomiting, diarrhea or asthma. Babies may even fail to thrive. These are non IgE mediated reactions. Cow's milk protein intolerance is an example of this - sometimes you will see blood in the stool. How is Cow's Milk Allergy diagnosed? The first thing is a good story (history) of a reaction after having cow's milk. If your infant has had an immediate reaction, then skin prick tests, or blood tests (such as CAP, EAST, RAST) will usually be helpful. These tests detect IgE mediated allergies. In other cases, milk and dairy products may need to be eliminated from the diet in a trial of treatment. If the symptoms resolve and then return when milk is reintroduced into the diet, this is diagnostic for allergy - called Elimination/Reintroduction. If your child has had a severe reaction to milk products, then reintroduction should be done under medical supervision. Some centers offer patch testing, which may be useful in detecting non IgE mediated allergies. What is the treatment of cow's milk allergy? Cow's milk will need to be excluded from your baby's diet. This can be difficult and you may need the help of a dietician. Some breast-fed babies will get symptoms if their mother has cow's milk (dairy) products in her diet. In these cases, the mother will need to exclude dairy products from her diet. Foods to be avoided in cow's milk allergy include: any food with cow's milk or goat's milk cheese butter ghee milk powder cream fraiche, sour cream, cottage cream whey casein margarine custard lactalbumin, lactulose, lactoglobulin any foods containing any of the above list What milk alternative should I feed my infant with cow's milk allergy? Alternatives to cow's milk include: soy protein formula - about half children who are allergic to cow's milk will also be allergic to soy. Soy formula is not recommended for infants under 6 months but can be tried first as an alternative milk in infants over 6 months of age extensively hydrolysed formula (EHF) - this is milk that has been treated to break down most of the enzymes that cause allergic symptoms. These are the first choice alternative for infants under 6 months with cow's milk allergy. Examples of EHF include PeptiJunior and Alfare. Partially hydrolysed formula (PHF) are not suitable for cow's milk allergic infants amino acid based formula - AAF - this is milk that is completely broken down eliminating the protein that causes allergy. It will be necessary in about 10% of cow's milk allergic children. Examples of an amino acid based formula include Neocate and Elecare. AAF should be used in children who do not tolerate EHF (after a 2-4 week trial) or as a first choice in infants with an anaphylactic reaction Should I give my baby goat's milk for cow's milk allergy? No. Goat's milk and cow's milk share similar proteins so children who are allergic to one will be allergic to the other. Goat's milk, sheep's milk, and rice milk are not suitable alternatives in cow's milk allergic children. Should I stop breast-feeding my cow's milk allergic baby? No, keep breast feeding your baby. Cow's milk allergy is less likely in breast fed infants. If your baby has symptoms of cow's milk protein allergy, then you should exclude dairy products and eggs from your diet - you need to continue this for at least 2 weeks, but probably for 4 weeks, to see if there is an improvement. If there is improvement, one food per week can be introduced into your diet until you know what food is causing your baby's problems and then you can just avoid that food. If you need to continue to eliminate milk from your diet, you may need a calcium supplement. When you do wean your baby, you should use an extensively hydrolysed formula (or soy if your baby is over 6 months of age). Will my child grow out of her allergy? Most children grow out of their cow's milk allergy by age 3 years. Once your child is over 12 months old and has been without diary in the diet for at least 6 months, you could try introducing some cow's milk into the diet - you might want to start with yoghurt or cheese as these are sometimes tolerated better than actual milk. If your child had a severe reaction to the milk in the first place, like anaphylaxis, then you should have the milk challenge under medical supervision - do not try re-introducing milk at home. Some children grow out of the dairy allergy but develop other allergic diseases, like asthma as they grow older. Does diary allergy cause mucus? Symptoms that relate to the respiratory system, such as runny nose and mucus, usually are a result of what we breath not what we eat. Any symptoms of mucus after ingesting milk are not dangerous and in infants are more likely to be the result of a respiratory tract infection rather than an allergy. Is eczema caused by milk allergy? In most cases of eczema, there will not be any allergy. However, some infants, particularly young babies with severe eczema, allergy may be a factor. In these cases, skin prick tests may be positive and even if they are not, it may be worthwhile trying an elimination diet (no dairy or cow's milk) for 4 weeks to see if there is improvement. If no improvement occurs, cow's milk is unlikley to be contributing to the eczema. What is lactose intolerance? Lactose intolerance occurs because the body lacks an enzyme, lactase, that is necessary to digest the milk sugar, lactose. People with lactose intolerance will get diarrhea, vomiting and tummy pains - these symptoms are similar to cow's milk allergy, but do not involve the skin. Although the symptoms are a nuisance, lactose intolerance is not dangerous. If you have lactose intolerance, you can usually manage to eat small amounts of cow's milk. Other dairy products, such as yoghurt and cheese, are usually well tolerated because they have easier to digest milk sugars. The diagnosis is made on a stool test which shows sugars (reducing substances) in the stool or a breath hydrogen test. Treatment is reducing or avoiding products containing lactose (milk sugar) - so reducing or avoiding dairy. Infants require a lactose-free formula.