• The cow’s milk protein is present in all formula milk products. When such products are introduced into the baby’s system, this could cause allergic reactions
• The ideal would be for the mother to exclusively breast feed the baby as long as possible and weaning other foods should begin after 6 months

Baby milk formula has been a true facilitator to working mothers, mothers who are unable to produce breast milk and adoptive parents. However, there has been a rise in the number of babies receiving allergies due to the frictional proteins found in cow’s milk. This entity is called cow’s milk protein allergy. To expand our knowledge on the subject the Daily Mirror spoke to Dr. Kosala Karunaratne, Consultant Pediatrician of the Lady Ridgeway Hospital.   

 Background to the disease
Dr. Karunaratne gave the Daily Mirror a brief background on the subject. He said, “Man is a mammal. Therefore all mammals feed their offspring with milk from birth. In contrast to other mammals, even primates, the human baby takes a long time to grow. The cow especially, takes only a few years to grow. Though all mammals produce milk they produce milk that will complement the growth of their offspring. Since the cow’s growth rate is very fast their calf need more proteins than humans.

Therefore, they have a higher concentration of protein and the constitution and structure of their proteins differ from humans. Cow’s milk carry a protein called beta lacto goblin, whereas humans carry a protein called Alfa lactam albumin. Thus if a human baby is exposed to cow’s milk the protein becomes a foreign entity to the baby. Therefore, the immune system of the baby’s recognizes the protein as antigenic, and mounts a response against it. The allergy can be brought on by giving cow’s milk products to the baby. Whether it is an expensive formula milk product or an unmodified cow’s milk the cow’s milk protein is difficult to modify structurally. Therefore the antigenicity remains constant”.  

In contrast to other mammals, even primates, the human baby takes a long time to grow. The cow especially, takes only a few years to grow. Though all mammals produce milk they produce milk that will complement the growth of their offspring. Since the cow’s growth rate is very fast their calf need more proteins than humans. Therefore, they have a higher concentration of protein and the constitution and structure of their proteins differ from humans

He further said, “This response of the immune response can manifest many symptoms in the baby. These symptoms can be either subtle or dramatic. The subtle symptoms may not be even detected at first instance, such as growth and nutrition problems”  

Symptoms 
Dr. Karunaratne said, “The cow’s milk protein is present in all formula milk products. When such products are introduced whether it is from the birth or after the mother resumes working, the cow’s milk protein are introduced into the baby’s system and this could cause allergic reactions. Broadly speaking there are two main groups of the cow’s milk protein allergy. One group is where the symptoms can be perceived rapidly, such as skin allergies (hives, rashes etc.) or where the baby suddenly collapses after an anaphylactic reaction (an extreme, allergic reaction to an antigen to which the body has become hypersensitive). When there are dramatic reactions it is easier to halt the allergic reaction as it is easily identifiable and thus curable. The reaction that is borne immediately is called the IgE mediated allergic reactions. In lay terms it means the immune system of the body is acting directly to the foreign protein in the system of the baby”.  

Parents and a few doctors feel that lactose free milk powders are healthy option in contrast to the conventional cow’s milk formula. However, in such formulas the sugar lactose is excluded rather than the cow’s milk protein. Therefore the lactose free formula is not a solution to this predicament

Elaborating on the other group of symptoms which are rather subtle, he said, “These are non-IgE mediated reactions to cow’s milk protein. This is the immune system acting indirectly and where the symptoms show after a delay. The symptoms can be perceived as follows: loose stools- where the it can be greenish or blood stained or frank blood clots and can be easily mistaken as a infective diarrhea, growth failure- where the child can have anemia through the blood loss of the stools, unexplained vomiting, allergic march- this begins with eczema on the face which concludes with asthma. It is rather difficult to diagnose the exact cause of such symptoms because the symptoms are on late on set. Such symptoms are thus misdiagnosed for other diseases”.  

“There is also a rare form of cow’s milk allergy which is non-IgE which is called FPIES (food protein induced entero colitis). The mother cannot give this allergy through breast milk, but the baby can get severe immediate symptoms such as severe vomiting and collapsing. Though it is non-IgE mediated it is dramatic and severe. It can also be caused by the baby eating soya meat and eggs,”he said. 

Treatment 
Dr. Karunaratne said, “There are some situations where the mother has no choice but to give an alternative milk. Since cow’s milk proteins cause allergies there are solutions to this predicament. A doctor could recommend hypoallergenic formulas. In these formulas the size of the protein has been modified and reduced and thus the allergic reactions are less. However even these milk products can cause allergic reactions. Therefore, if the baby is still getting the symptoms, a pediatrician should be consulted to receive special milks. There are two types of special milks that would be prescribed: protein hydrolyzed milk powder: this is where the protein is completely modified and the size of the protein is reduced and amino acid based milk powder: where the protein size is even more reduced because the basic protein structure is amino acid (the smallest unit of protein). However amino acid based milk powder unfortunately is not readily available in Sri Lanka”. 

 
 Dr. Karunaratne warned against the use of lactose free milk powders. He said, “Parents and a few doctors feel that lactose free milk powders are healthy option in contrast to the conventional cow’s milk formula. However, in such formulas the sugar lactose is excluded rather than the cow’s milk protein. Therefore the lactose free formula is not a solution to 
this predicament”.  

Further, he said, “There are soy milk formulas as well, but they have similar proteins as the cow’s milk. Therefore, allergies could still prompted by soy milk.   

When cows milk allergy is suspected in the baby the mother should restrict cow’s milk intake herself especially if she is breast feeding as her milk could also contain the cow’s milk protein, and thus cross over to the baby,”he said. 

What should I do as a parent?
The ideal would be for the mother to exclusively breast feed the baby as long as possible and weaning other foods should begin after 6 months.  

If you think the baby has symptoms due to cow’s milk visit your local general practitioner immediately for a prescription for alternative type of milk powders.  

If the parents have a history of atopy (eczema, asthma and rhinitis) the General Practitioner could recommend a hypoallergenic formula.  

If the child is getting serious reactions a pediatrician should be consulted where a special milk can be recommended. Serious allergenic symptoms cannot be treated with a hypoallergenic formula.