It's estimated that 40% of children in the US are impacted by multiple food allergies.1 In this article, we will focus on infants and the presentation of food allergies, diagnosis, and alternative feeding options to consider for infants who are impacted.
Food allergies occur when the immune system responds abnormally to a specific food. This immune-mediated response will reoccur every time that certain food is consumed. Note that food allergies are different from food intolerance (a non-immune-mediated reaction) because food intolerance doesn't involve the immune system.2
There are 4 kinds of immune-mediated reactions2:
Undiagnosed food allergies can be extremely harmful to infants, so recognizing the symptoms and providing an early diagnosis is key.
Diagnosing food allergies can include reviewing the patient’s medical history, performing a medical examination, eliminating certain foods from the lactating mother's diet to see if symptoms cease or persist, or a trial of hypoallergenic formula, if necessary. Note: For IgE-mediated food allergies, predictive value tests can help physicians confirm a food allergy diagnosis, but these tests are not considered diagnostic on their own.2
Breastfeeding is the optimal nutrition source for infants. However, it can be challenging to manage food allergies in breastfeeding infants, as there is a limited amount of data published on the presence of food proteins in human milk, and food elimination diets may adversely impact the nutritional status of the lactating mother. If parents choose to continue breastfeeding and try an elimination diet, they should work closely with their healthcare provider throughout the process. If parents decide to pursue formula-feeding options instead, finding a nutrition product that works for their infant with food allergies may require trying multiple formulas.
Depending on the infant's immune reaction, here are some possible formula-feeding options to consider2,4:
Developing the skills and awareness to recognize how infant food allergies present in our patients can help remediate an infant's immune response. By providing the feeding option that best addresses the child with food allergies, you can help your patients and their caregivers enjoy a higher quality of life.
References: 1. Warren CM, et al. Ann Allergy Asthma Immunol. 2023;130(5):637-648.e5. 2. Boyce JA, et al. J Allergy Clin Immunol. 2010;126(6 suppl):S1-S58. 3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy, Oria MP, Stallings VA, eds. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington (DC): National Academies Press (US); November 30, 2016. 4. American Academy of Pediatrics Committee on Nutrition. Formula Feeding of Term Infants. In: Greer FR, Abrams SA eds. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025:108.
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.
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,1-9 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:
CMA symptoms typically appear within the first few months of an infant’s life, usually before 6 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).
If your patient is confirmed to have CMA, here are some tips and next steps you might recommend to their parents:
Avoid assuming that an infant with CMA will have other food allergies as well. Encourage parents to check with you before eliminating foods from their infant's diet.
Managing cow’s milk allergy can be overwhelming and difficult for parents and caregivers. You may not be able to provide immediate relief, but you 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 CMA and supporting parents of infants who may be impacted.
References: 1. Kattan J. Curr Allergy Asthma Rep. 2016;16(7):47. 2. Boyce JA, et al. Nutrition. 2011;27(2):253-267. 3. Fiocchi A, et al. Pediatr Allergy Immunol. 2010;21 (Suppl 21):1-125. 4. Lee AJ, et al. Asia Pac Allergy. 2013;3(1):3-14. 5. Venter C, et al. Pediatric Clinics. 2011;58(2):327-49. 6. Osborne NJ, et al. J Allergy Clin Immunol. 2011;127(3):668-676 7. Schoemaker AA, et al. Allergy. 2015;70(8):963-972. 8. Bock S, et al. Pediatrics. 1987;79(5):683-688. 9. Gupta RS, et al. Pediatrics. 2011;128(1):e9-e17.
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