May is National Allergy Awareness Month in the United States, but it’s always a good time to raise awareness for cow’s milk allergy (CMA) in infants as well as share essential tips to help support parents. 

An Overview of Cow’s Milk Allergy

CMA is an immune system reaction to the protein in cow’s milk. Approximately 3% of infants and children around the world develop CMA in their first year of life, making it one of the most common food allergies found in infants.

CMA can be a result of an immature immune system or genetic factors. Common symptoms can include:

• Skin reactions such as hives, eczemas, redness around the mouth, or swelling of lips, tongue, eyes, and/or face
• Gastrointestinal issues like vomiting, diarrhea, abdominal pain, or blood in the stool
• Respiratory issues like coughing, wheezing, or shortness of breath
• Other symptoms like fussiness, irritability, or refusal to feed

CMA symptoms typically appear within the first few months of an infant’s life, usually before six months. Symptoms can present a few days or weeks after ingesting cow’s milk protein (slow onset, non-IgE mediated), or occur within an hour after ingestion (rapid onset, usually IgE mediated). 

Post-Diagnosis Cow’s Milk Allergy Tips & Guidance for Parents

If your patient is confirmed to have CMA, here are some tips and next steps you might recommend to their parents:

1. Dietary Management.
   • breastfeeding: Breast milk is the ideal nutrition for infants, but it can become complicated when an infant is diagnosed with CMA. The lactating mother might consider trying a milk-free diet to see if the infant’s symptoms cease or persist. Remind mothers who are breastfeeding their infants to always work with their healthcare provider when changing their diets.
   • formula feeding: Consider a trial of specialized formula, such as hypoallergenic, extensively hydrolyzed protein-based, or soy protein-based formula.
2. Post-Diagnosis Symptom Resolution. Healing may take time. If the infant has protein sensitivity, parents may see improvement in tolerance and reduced colic symptoms within a few days of starting a hypoallergenic formula. However, it may take 2-4 weeks for gastrointestinal (GI) inflammation to improve. During this period, parents should monitor for improvements in symptoms such as vomiting, diarrhea, and blood in the stool. Work closely with parents to monitor their infant's progress and make any necessary adjustments to their diet.
3. Further Feeding Options. You may need to recommend an amino acid-based formula if symptoms persist or do not improve after 2-4 weeks of feeding a specialized formula.
4. Other Important Reminders for Parents:
   • Most children outgrow their milk allergy in time.
   • Milk allergies are different from lactose intolerance.
   • Communication is key. Encourage parents to share information about their infant’s food allergy with family members, daycare staff members, or anyone else providing care for their child.

Avoid assuming that an infant with CMA will have food allergies as well. Encourage parents to check with you before eliminating foods from their diet.

Our Role in Supporting Impacted Families

Managing cow’s milk allergy can be overwhelming and difficult for parents and caregivers. We may not be able to provide immediate relief, but healthcare professionals can help support them throughout their experience by offering helpful tips and anticipatory guidance.

This National Allergy Month, please join me in spreading awareness of cow’s milk allergy and supporting parents of infants who may be impacted.