As long as you are breastfeeding, you’ll need to take great care with what you eat and drink on a daily basis.

If you aren’t careful, whatever you ingest may enter your breastmilk, which might cause an allergic reaction in your little one.

For instance, when you consume cow’s milk, its proteins may bind with your breastmilk and if your kewpie is allergic to these proteins, it may even prove fatal.

Dr Ong Eng Keow, a paediatrician at International Child & Adolescent Clinic at Mount Alvernia Hospital, notes that the symptoms of an allergy to cow’s milk may appear in mere minutes to sometimes days after your cherub drinks your breastmilk.

“Symptoms that occur slowly over several hours, or sometimes days, include diarrhoea, often with streaks of blood, wheezing, rashes like eczema flares, and over a prolonged period of time, compromises your child’s ability to grow very well.”

Do note, however, that the symptoms of an allergy to cow’s milk — also referred to as Cow’s Milk Protein Allergy (CMPA) — share many similarities with that of lactose intolerance.

However, Dr Ong explains that unlike CMPA, lactose intolerance doesn’t involve the immune system. Its symptoms are often milder such as bloating, gas or diarrhoea after consuming milk or milk products.

On the other hand, infants with CMPA may display signs of life-threatening reactions such as anaphylaxis — a situation where their airways are blocked and causes breathing difficulties. It can be fatal if bubba doesn’t get medical treatment immediately.

Infants with CMPA may display signs of life-threatening reactions such as anaphylaxis — a situation where their airways are blocked and causes breathing difficulties. It can be fatal if bubba isn’t given medical treatment immediately.

Dr Ong points out that other instant signs of an allergic reaction to cow’s milk in infants include wheezing, vomiting and hives — raised red patches of skin all over your child’s body. Although these severe allergic responses are less common, if it happens, bring your child to their paediatrician immediately.

The good news is that the incidence of CMPA is relatively low in Singapore. Dr Ong says that an estimated 0.5 per cent of children here suffer from it ― he usually treats about five cases a year in his clinic. Dr Ong has important advice on CMPA…

If an infant has been diagnosed with asthma or eczema, does this mean they are at a higher chance of suffering from a milk allergy?

Yes, but more so for those with moderate to severe eczema. Coughing and wheezing as signs of a possible cow’s milk protein allergy are uncommon. Usually, there will be two types of symptoms ― either in the gastrointestinal system, on the skin surface or respiratory system.

Can an allergic reaction to cow’s milk be fatal?

CMPA is rarely fatal unless it is diagnosed to be a strain with immediate onset, which is not common. However, once diagnosed with CMPA, adequate precautions must be taken to avoid milk.

What tests are carried out to diagnose CMPA?

Most of the time, a comprehensive patient history is all that’s required for the diagnosis of CMPA. Those suspected to have the immediate onset type of CMPA may need skin-prick tests and blood tests. Those with delayed onset usually do not need any specialised tests. During a skin prick test, your skin is pricked and exposed to small amounts of milk proteins. If you’re allergic, you’ll develop a raised bump — called hives — at the test location on your skin. Otherwise, the doctor may also do a blood test to measure your immune system's response to milk by measuring the amount of immunoglobulin-E or IgE antibodies in your blood.

However, you should note that both tests may not be always accurate in diagnosing CMPA. So, if your examination and test results can’t confirm a milk allergy, your doctor might administer an oral challenge. The patient will be fed different foods that may or may not contain milk in increasing amounts to see if there are any adverse reactions to the ones that do contain milk. Parents should note that allergy tests are best administered by an allergist who’s trained to manage serious reactions.

Will a child ever outgrow their milk allergy?

A milk allergy typically presents in the first year of life. The majority of children outgrow milk allergy by age 10 One large clinical trial reported that 19 per cent of children are able to resolve their milk allergy by age 4, 42 per cent by age 8, 64 per cent by age 12 and 79 per cent by age 16. Even though your child may have CMPA, they may be better able to tolerate milk as an ingredient in baked goods, relative to liquid milk. You should also know that some patients who have CMPA may also have an allergic response to beef ― more so to rare beef versus the well-cooked varieties.

What preventive measures can parents take?

If a mum is nursing, the paediatrician will most likely recommend avoiding milk products to the mum and replace it with calcium and vitamin D supplements instead. If your baby is formula fed, sometimes, paediatricians will recommend switching to a soy-based formula. These formulas contain soybean proteins, vitamins and minerals instead of those found in cow’s milk. This switch usually resolves about the issue for half the babies allergic to cow’s milk. For babies who still have persistent reactions to milk proteins, paediatricians may recommend hypoallergenic formulas.

“Also, study the label for words such as ‘may contain’ — milk may not be an ingredient but the food may be made in a factory which also produces milk products.”

There are two varieties:

* Hydrolysed formulas These contain proteins that have been broken down, so they are easily digested and less likely to cause a reaction. Examples include Nutramigen, Alimentum and Pregestimil.

* Elemental formulas These contain proteins in their simplest form and are used when hydrolysed formulas continue to cause symptoms. These include Neocate and EleCare.

Once you switch your baby to another formula, the symptoms of the allergy should go away in two to four weeks. Even then, your doctor will probably recommend that you continue with a hypoallergenic formula until your baby’s first birthday before gradually introducing cow’s milk into his or her diet.

Unfortunately until then, the only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contain milk or milk products, so parents will need to extra mindful when they shop and prepare foods.

What ingredients should parents look out for when buying food products?

Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yoghurt, cheese, cottage cheese, cream. Anything with casein, whey, butter, and sadly, chocolate as well. Look out for any ingredients that begin with "lac" such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese. Also, study the label for words such as “may contain” — milk may not be an ingredient but the food may be made in a factory which also produces milk products.

What are the treatment options?

Despite your best efforts, if you or your child accidentally consumes milk, medications such as antihistamines may reduce mild signs and symptoms of an allergic reaction. Taken after exposure to milk, an antihistamine may help relieve discomfort. If you or your child has a serious allergic reaction — such as going into anaphylaxis — you may need an emergency injection of epinephrine and a trip to the emergency room. If so, you or your child may need to carry an injectable epinephrine, commonly known as EpiPen and Auvi-Q, at all times. Ask your doctor to demonstrate how to use this device correctly, so that you’re prepared for an emergency.

Photos: iStock

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