Child Growing small croppedWhen should the symptoms disappear after eliminating cow’s milk protein from my child’s diet?

If your child has been correctly diagnosed with cow’s milk allergy (CMA) and you have successfully removed cow’s milk protein from the diet it can take a little while for the body to get back to normal.  The process is much like waiting for a cut to heal. For most infants and children symptoms should improve within two to four weeks of eliminating cow’s milk protein from the diet1. It is, however, important to discuss this with your doctor as this timeframe may vary.

Eliminating cow’s milk protein is challenging.  After it has been removed from the breastfeeding mother’s diet or your child has been changed to a suitable formula, you are well on track to managing the allergy.  Of course, if cow’s milk protein is consumed, either through changing formula or in the diet of the breastfeeding mother, symptoms could return.

If your infant is prescribed an extensively hydrolysed formula (eHF) and symptoms do not improve after two to four weeks, your doctor might consider switching to an amino acid based formula (AAF). If symptoms do not disappear on an AAF it may be time to consider a different diagnosis1.

What are eHFs?

Extensively hydrolysed formula is a cow’s milk-based formula treated with enzymes.  These enzymes ‘digest’ or break down most of the proteins that cause symptoms in allergic infants2. Some sensitive children may still react with the tiny cow’s milk fragments found in these formulas. For these children AAFs are recommended.

What are AAFs?

Amino acid based formulas are made up of synthetic amino acids.  Amino acids are the building blocks that make up protein. These formulas are suitable for the dietary management of children allergic to cow’s milk or with multiple food allergies4. AAFs are necessary in around 10% of children with cow’s milk allergy1

 When should my child’s condition be reviewed?

All children with CMA should have regular follow up with their doctor.  Your child’s doctor will be looking out for3;

  • Growth
  • Height
  • Improvement of symptoms and any ongoing symptoms
  • General health
  • How you and your child are managing the cow’s milk free diet

Children with CMA will generally need to follow a cow’s milk free diet for at least 6 months after diagnosis1.  Eventually the check-ups will also assess if your child is ‘out growing’ the allergy and if cow’s milk can be re-introduced into the diet

Will my child grow out of cow’s milk allergy?
The good news is that most children out grow cow’s milk allergy. By the age of 3-5 years around 80% of children will be able to re-introduce cow’s milk into the diet without any symptoms3.  In some cases, however, the allergy persists although it is very rare for symptoms to continue into adulthood2

Your doctor will re-evaluate your child periodically to check if it is safe to re-introduce cow’s milk. This process may include several tests, such as skin prick testing, blood tests, and/or oral food challenges1.  The type of tests required will depend on the severity of the allergic reaction.

Don’t worry if your child still shows ‘positive’ reactions in skin or blood tests. A positive allergy test does not necessarily mean that your child is allergic.  It may be that a food challenge, under the direction of a paediatric specialist, may be needed to prove that CMA has finally gone away5

 

  1. Vandenplas et al 2007 ‘Guidelines for the diagnosis and management of cow’s milk protein allergy in infants’ Arch Dis Child Vol 92 pp: 902-908
  2. ASCIA, 2016, Cow’s milk (dairy) allergy, Australasian Society of Clinical Immunology and Allergy, viewed 19 May 2016, http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy
  3. Motala & Fiocchi, 2012, Cow’s milk allergy in children, World Allergy Organisation, viewed 20 May 2016, http://www.worldallergy.org/professional/allergic_diseases_center/cows_milk_allergy_in_children
  4. 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.
  5. ASCIA, 2016, Food Allergy, Australasian Society of Clinical Immunology and Allergy, viewed 20 May 2016, http://www.allergy.org.au/patients/food-allergy/food-allergy