Cow’s Milk Protein Allergy in Infants: Frequently Asked Questions

When a germ like a cold virus enters your baby's body, her immune system releases chemic​als like histamines to fight it off. This is good because it keeps your baby healthy. Sometimes though, immune systems get a little overprotective and cause the body to attack things that aren't really bad for it, such as the proteins found in cow's milk. Once your little one's immune system identifies cow's milk protein as a health threat, it will want to battle this protein every time she consumes a cow’s milk-based product like some routine infant formulas. This results in persistent allergic reactions like hives, rashes, and respiratory and digestive problems. While it might be upsetting to hear that your baby can't have dairy products, there is a very good chance that this won't always be the case. Most children outgrow their cow's milk protein allergy by school age.^1,2 Still, you should introduce your child to foods made with cow's milk protein only while under the supervision of your baby’s doctor.

The type of reactions—and their severity—vary from baby to baby depending on the degree of individual sensitivity to cow's milk protein. Most babies with cow's milk protein allergy experience mild to moderate reactions—colic, reflux, diarrhea, constipation, gas, skin rashes, chronic cough, runny nose and wheezing—days after ingesting cow's milk protein. Severe problems tend to be more apparent and can set in minutes to hours after exposure to a food allergen. They may include breathing difficulties, rectal bleeding, and anaphylaxis (severe abdominal pain, high-pitched breathing, irregular heartbeat and low blood pressure). Babies with cow's milk protein allergy also may appear irritated or distressed at feeding time, sleep poorly, or have trouble gaining weight. It is important to check with your baby’s doctor if you have any concerns about your baby’s health.

Not always. That's why it's important to see your pediatrician. Reactions can vary greatly depending on your infant's sensitivity to cow's milk protein. Babies with cow's milk protein allergy may experience colic, reflux and skin rashes. Then again, babies who are not allergic to cow's milk protein also can have these problems. Complicating matters is the fact that problems brought on by cow's milk protein allergy may not appear until days after consumption of a milk product. The connection between dairy in your baby's diet and her reactions might not be obvious.

If your doctor suspects your baby has cow's milk protein allergy, he or she will likely have you manage your baby's diet by eliminating cow's milk protein to see whether her problems improve. Because fragments of cow's milk protein can be passed from mother to infant in breast milk, nursing moms may be asked to eliminate milk products from their diets. You shouldn't stop nursing because breast milk provides the best nutrition for your baby. For formula-fed infants, an elimination diet involves switching to a formula that is hypoallergenic, meaning it has been specially designed to not cause allergic reactions in infants with cow's milk protein allergy. Hypoallergenic formulas include extensively hydrolyzed formulas (such as Nutramigen^® A+^®with LGG^® ) and amino acid-based formulas (such as PURAMINO A+^®).
In addition, your baby’s doctor may take a detailed medical history and perform a physical exam. He may order different tests (such as blood, stool or allergy skin prick tests). Your baby may also be referred to an allergist or other specialist such as a gastroenterologist or dietitian. Your baby’s doctor is in the best position to diagnose and treat your baby.

If your doctor or pediatrician believes your infant has cow's milk protein allergy, the first step he or she will likely recommend is to eliminate cow's milk protein from your infant's diet. Because cow's milk protein fragments can be passed from mother to infant in breast milk, nursing moms may need to follow dairy-free diets until their babies are weaned. Don't stop nursing! Breast milk provides the best nutrition for your baby.
Formula-fed infants may need to switch to a formula that is hypoallergenic, meaning it has been specially formulated to not cause allergic reactions in infants with cow's milk protein allergy. Most babies with cow's milk protein allergy do well with an extensively hydrolyzed, hypoallergenic formula. The cow's milk protein in these formulas has been extensively broken down or hydrolyzed into small pieces, so they are less likely to cause allergic reactions. Nutramigen^® A+^® with LGG^® is an extensively hydrolyzed, hypoallergenic formula.
Rarely, a small number of infants with cow's milk protein allergy react severely to cow's milk protein. These infants may need a hypoallergenic formula made from free amino acids, the building blocks of proteins. PURAMINO A+^® is an amino acid-based formula.
Cow's milk protein allergy often goes away on its own by the time a child is school age^1,2. Still, you shouldn't reintroduce dairy into your child's diet without your doctor's consent and supervision.

Experts aren't sure why certain babies become allergic to cow's milk protein. It often develops for no apparent reason within an infant's first year. What is known: Your baby has a higher risk of developing cow's milk protein allergy if there is a family history of allergies to foods such as cow's milk, soy, eggs, wheat, peanuts, tree nuts, and fish; or a family history of hay fever, asthma or eczema.

Yes, many babies are allergic to cow's milk protein. Cow's milk protein allergy occurs in 2.2%-2.8% of infants.^1-3

It's possible. Many babies with cow's milk protein allergy also are allergic to soy protein.

Probably not. Most children will outgrow cow's milk protein allergy by school age.^1,2 You should introduce your baby to foods made with cow's milk only while under a doctor's supervision.

Cow's milk protein allergy is an immune system response to milk proteins such as casein and whey. Lactose intolerance is a digestive system response to a milk sugar called lactose. Infants who are lactose intolerant lack an enzyme needed to digest this milk sugar. Cow's milk protein allergy and lactose intolerance share a few symptoms, such as gas, abdominal pain and diarrhea. But unlike cow's milk protein allergy, lactose intolerance doesn't engage the immune system and cause allergic reactions such as hives, skin rashes, breathing problems, or chronic runny nose and cough. Another key difference is the age that children develop these problems. Cow's milk protein allergy is more common in infancy. Lactose intolerance is much more likely to affect children age three years and older. Even then, it is very rare

Your doctor may refer you to a pediatric allergist or a pediatric gastroenterologist (a doctor who specializes in children's digestive problems). Because some processed foods like breads, cereals and crackers contain hidden dairy ingredients, you also may want to see a dietitian as you start to feed your baby solid foods. A dietitian can help ensure that your baby gets the nutrients needed for healthy growth and development while consuming a dairy-free diet.

Nutramigen^® A+^® with LGG^® can be purchased in stores. Nutramigen^® A+^® with LGG^® and PURAMINO A+^® can be purchased online at the Specialty Food Shop and London Drugs or by special order through your pharmacist.

Nutramigen^® A+^® with LGG^® and PURAMINO A+^® infant formula may be available through various public and private drug benefits programs. Ask your doctor or pharmacist if you qualify for coverage under your private insurance, a provincial drug benefit plan, or another public drug insurance plan including: Alberta public programs, the Regie de l’assurance Maladie du Quebec's Public Prescription Drug Insurance Plan, the Saskatchewan Aids to Independent Living Program, or other plans.

Nutramigen^® A+^® with LGG^® and PURAMINO A+^® are both hypoallergenic infant formulas that contain DHA, a type of Omega-3 fat, and an important building block for a baby’s developing brain. Nutramigen^® A+^® with LGG^® is clinically shown to be effective in the dietary management of infant’s with cow’s milk protein allergy, including colicky infants.*

Most babies with a cow’s milk protein allergy do well on an extensively hydrolyzed formula such as Nutramigen^® A+^® with LGG^®, however, in some severe cases, an amino acid-based formula (such as PURAMINO A+^®) may be recommended.

Amino acid-based formulas are made with free amino acids, the building blocks of proteins. An amino acid-based formula like PURAMINO A+^® contains no cow's milk protein. PURAMINO A+^® is scientifically designed for effective dietary management of infants and toddlers with severe cow's milk protein and/or multiple food allergies.

Nutramigen^® A+^® with LGG^® and PURAMINO A+^® are not kosher or halal. The protein in Nutramigen^® A+^® with LGG^® is hydrolyzed or broken down by an enzyme process using pork pancreatic enzyme. Very little of the enzyme remains in the final product. In fact, pork contributes an insignificant percentage of the prepared formula. PURAMINO A+^® contains kosher ingredients but is not kosher certified because it is manufactured on the same line as Nutramigen^® A+^® with LGG^®. If Nutramigen^® A+^® with LGG^® or PURAMINO A+^® are medically necessary for your baby, some rabbis provide exceptions for use of the product.

Nutramigen^® A+^® with LGG^® has a unique odour and taste due to the special protein that makes the formula effective for babies with cow’s milk protein allergy.

A baby’s taste buds take time to develop in the early stages of life, therefore, we would not expect a young baby to refuse Nutramigen^® A+^® with LGG^® based on taste alone. Young babies tend to be accepting of the formula; some babies (particularly older babies) may take 3-5 days to become accustomed to the unique taste. If this is your baby's first experience with the product, continue offering it as much as possible for several days. Sometimes, offering small, frequent feedings will help with this adjustment.

Remember, babies with cow's milk protein allergy have been drinking—and enjoying— Nutramigen^® formula for over 70 years. Your baby's taste buds are more receptive to new flavours than yours. In fact, in one study1, after seven months on a Nutramigen^® A+^® with LGG^® diet, most babies prefer the taste of this formula over routine ones.

Both Nutramigen^® A+^® with LGG^® and PURAMINO A+^® have all of the essential vitamins and nutrients infants need for healthy growth and development. Both formulas also contain DHA , a type of omega-3 fat an important building block of a baby's developing brain.

Protein is the food component that can trigger allergic reactions. Nutramigen^® A+^® with LGG^® and PURAMINO A+^® contain soy oil, not soy protein. The soy oil is purified, refined and hypoallergenic. We would not expect it to cause an allergic reaction. However, if you have any concerns, please consult with your baby’s doctor.

There is a significant difference between a partially hydrolyzed formula and an extensively hydrolyzed formula. Many babies that are allergic to cow’s milk protein will still have allergic reactions on a partially hydrolyzed formula. Therefore, the American Academy of Pediatrics does not recommend the use of a partially hydrolyzed formula for babies with cow’s milk protein allergy.

Many babies who are allergic to cow’s milk protein may also be allergic to soy protein. Therefore, experts such as the Canadian Pediatric Society and American Academy of Pediatrics do not recommend the use of soy formulas for babies who have cow’s milk protein allergy.

The scientific process involved in making formulas safe and hypoallergenic for infants with cow's milk protein allergy is extensive and costly. In addition, both Nutramigen^® A+^® with LGG^® and PURAMINO A+^® are continually monitored and researched to ensure their potential for causing cow's milk protein allergy symptoms remains low while their nutritional value stays high. This adds extra expense.
Nutramigen^® A+^® with LGG^® and PURAMINO A+^® infant formula may be covered through provincial drug benefits programs. Ask your doctor or pharmacist if you qualify for Alberta Health and Wellness, Ontario Drug Benefit Program, Regie de l’assurance Maladie du Quebec or the Saskatchewan Aids to Independent Living Program.

PURAMINO A+^® isn't just for newborns. There is no need to switch formulas if your baby takes PURAMINO A+^® because it is formulated as a sole source of nutrition for infants up to six months, and as a major source of nutrition through two years. Your baby should remain on PURAMINO A+^® hypoallergenic formula for as long as your doctor recommends. You should introduce your baby to foods made with cow's milk only while under a doctor's supervision.

It's not uncommon for infant stools to vary in colour from day to day (and even from diaper to diaper). Colour changes may be more noticeable, though, when your baby switches formulas, including a transition to a hypoallergenic formula such as Nutramigen^® A+^® with LGG^® or PURAMINO A+^®. Generally, stools that have an earth-tone color—yellow, green, brown, or tan—are normal. Call your doctor if the stools are white, red or black.