Australian guidelines advise that there are 3 types of formula appropriate for treating infants with cows’ milk allergy1. They are extensively hydrolysed and amino acid-based formulas (these are discussed in the section ‘What are the types of infant formula’) or soy based formulas. For older children, there are also a number of milk substitutes that are appropriate. The best formula or cows’ milk substitute depends on your child’s age and whether they have other food allergies.
Soy based infant formulas
Soy based infant formulas contain a protein that is derived from soy flour. They are also made up of a mixture of carbohydrates, in the form of sucrose and corn syrup. Of the children with cows’ milk allergy, 20-50% are also allergic to soy4. For those infants that are not allergic to soy and that are diagnosed with cows’ milk protein allergy after 6 months of age, soy based infant formulas may be a reasonable substitute1. It is recommended that the introduction of soy based formulas is done in partnership with your healthcare professional.
Soy formulas should not be used in infants under the age of 6 months1. While only small amounts of infants have been studied in this age group, higher rates of adverse reactions to soy protein have been seen in infants under 6 months of age3
Soy milk is not suitable as an alternative to breastmilk or cows’ milk based infant formula in infants under 1 year4. It may, however, be able to be included as part of the diet after 1 year of age for children that are not also allergic to soy. A calcium fortified soy milk can be used and mixed into foods, for example on cereal, or in cooking. It is important to to consult your health professional before introducing soy milk into your child’s diet.
Cereal based milks: rice, nut and oat milks
Rice milk, oat milk and nut milks (such as almond or cashew milk) are not suitable for children under 1 year of age2. These drinks provide inadequate amounts of nutrients such as protein, calcium and iron that are required for healthy growth and development in this age group. For older children with cow’s milk and soy allergy, these milks are generally well tolerated. For children aged 1-2 years with slow growth, inclusion of these drinks should be done with supervision of your child’s healthcare professional.
Other mammal milks
The use of milk from other mammals, such as goats and sheep, is not recommended for the treatment of cow’s milk allergy1. These milks contain proteins that are similar to those found in cow’s milk and may trigger similar allergic symptoms in your child.
A2 milk is also not suitable for children with cows’ milk allergy. It contains all of the same proteins that are found in cow’s milk, with the exception of A1 beta casein2. Children that have cow’s milk allergy will experience the same symptoms with cows’ milk and A2 milk.
- Kemp et al. 2008, Guidelines for the use of infant formulas to treat cow’s milk protein allergy: An Australian consensus panel Med J Aust; Vol 188 no. 2, p. 109-112.
- Royal Children’s Hospital Melbourne, 2013, Cow’s milk allergy Diet Sheet Royal Children’s Hospital Melbourne, viewed 12 May 2016 http://www.rch.org.au/allergy/parent_information_sheets/Parent_Information_Sheets/
- ESPGHAN Committee on Nutrition, 2006, J Pediatr Gastroenterol Nutr; Vol. 42, No. 4, p. 352 – 361.
- ASCIA, March 2016, Cow’s milk (dairy) allergy Australian Society of Clinical Immunology and Allergy, viewed 12 May 2016, http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy
- NHMRC 2012 Australian Infant feeding guidelines: Information for health workers National Health and Medical Research Council, viewed 12 May 2016, https://www.nhmrc.gov.au/guidelines-publications/n56