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Something that came up with a family I have been supporting - Cows Milk Protein Allergy or CMPA.


Something that has come up recently with one of the families I have been supporting is Cows Milk Protein Allergy.


What is CMPA?

Cows milk protein allergy is an immune response to the proteins in cows milk. When the body consumes the allergen, the body becomes sensitised and the it remembers the protein as harmful. Therefore when it’s consumed, their body reacts thinking it is harmful.


The different types of CMPA:

There are 2 types of cows milk protein allergy, these are different depending on how your body’s immune system reacts.

There is an IgE allergy - this is an immediate allergy and usually happens within minutes, and up to 2 hours.

The other is non-IgE - this is a delayed reaction. This is slower to appear, and a different part of the immune system reacting. This reaction happens between 2 hours and 72 hours after consumption.

It is very rare, but there is a possibility of a combination of both types.


What are the symptoms?

IgE allergy - immediate:

Skin - during feeding or after:

  • Itchy skin,

  • Reddening,

  • Sudden flare of existing eczema,

  • Raised red bumps to the face or body (hives or wheals) - medical name : Urticaria,

  • Swelling - usually affecting the eyes, lips or face - medical name : angioedema.

Digestive system - during feeding or after:

  • Vomiting,

  • Loose stool (diarrhoea)

Breathing - during feeding or after:

  • Nose that is sneezy, itchy, runny and/or itchy, swollen, red eyes (without having a temperature)

  • Difficulty in breathing that comes on suddenly

  • Wheeze (whistling noise) heard because of narrowing of the breathing tubes

  • Difficulty swallowing (due to swelling in throat)

  • Cough - that comes on suddenly and is persistent

OTHER:

  • Floppy, pale, limp or unresponsive (unable to easily wake)


Non-IgE allergy - delayed reaction


Skin:

  • Itchy, red skin,

  • Rashes that come and go,

  • Quite severe eczema ( meaning it doesn’t go away, red, swollen, itchy, dry, and doesn’t really improve with treatment)


Digestive system:

  • Colic - repeated episodes of crying with no clear cause, sometimes they may bring their legs up to their tummy,

  • Wind - in pain before and during passing wind, increased amounts,

  • Reflux - bringing up milk or food, this can then be either spat out or swallowed again, this can be silent too which means you may not realise it’s happening, and they may just suddenly scream and gulp.

  • Vomiting - more than what is considered normal for a baby,

  • Mucus and/or blood in the stool - this can be seen in the nappy,

  • Straining for a poo even when soft, loose or hard,

  • Weight loss or not gaining weight - this doesn’t always happen though!


Behaviour:

  • Feeding refusal


What about Lactose Intolerance?

In cow's milk, three primary components include protein, sugar, and fat. In cow's milk allergy, the culprits are typically the proteins called casein and whey. However, some individuals may experience symptoms due to the sugar (lactose) in milk, known as Lactose Intolerance. It's crucial to distinguish between lactose intolerance and cow's milk allergy, as their management strategies differ significantly. Lactose intolerance has two distinct types. Understanding these differences is key to providing appropriate care.


Primary Lactose Intolerance -

This, in babies, is VERY rare. And it happens when there are reduced levels of the enzyme ‘lactase’ in the digestive system which is needed to break down lactose (the sugar in milk). Therefore the body cannot absorb it properly.

LI can happen after infancy when milk intake decreases, the enzyme decreases, meaning that the lactose that is being consumed is not broken down. This can cause an upset stomach, bloating, tummy pains, wind, loose stools - the same as a milk allergy. But it’s usually differentiated between due to one being from birth or early infancy, and the other not developing until later childhood/adolescence/adulthood.


Secondary Lactose Intolerance -

Secondary LI is pretty common after a bout of illness that disrupts the stomach or some sort of condition affecting the gastrointestinal system like coeliacs disease. It is temporary and has a cause, when the cause is resolved, soon after secondary LI is also.


What do I do if I think my baby has an allergy?

If you suspect an IgE allergy contact your GP immediately, but if concerning symptoms occur like swelling, difficulty breathing, unable to wake properly - call 999 immediately. If you suspect your baby may have a non-IgE allergy make sure to get a feeding assessment done to check for other causes first. Tongue tie can cause allergy like symptoms!


How is an allergy diagnosed?

An IgE allergy is usually diagnosed by blood test or a skin prick test. The blood test checks for an antibody in the blood, and the skin prick test pokes a needle into the skin with the allergen and looks for skin reaction.

Whereas, non-IgE is a process of eliminating other causes of the symptoms, and if there is no other explanation, then cutting out the allergen from the diet and seeing if there is improvement over time.


If my baby is diagnosed with an allergy, what will happen?

If you are breastfeeding, and want to continue, you should be encouraged and supported to do so. You will need to eliminate all cows milk products from your diet, even things like whey powder, buttermilk and milk powder. You’ll need to check all labels.

Look for products labelled; Non-dairy, Dairy-free, milk-free, Vegan, Animal-free dairy/ milk, Plant-based, Kosher, kosher dairy.

If you are not breastfeeding or make the choice to stop, or combination feed with formula, you will need switch from regular formula to a hypoallergenic formula prescribed by your GP.


There are support groups on Facebook if you are going through the experience of having a baby with an allergy. I will link them below, along with a link for more information on CMPA.


Further info on CMPA:

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