Cows Milk Allergy: Navigating Through the Diagnosis
In the last 6 – 12 months I have seen a rapid increase in a cow’s milk allergy (CMA) diagnosis walking into my clinic. I appreciate this. I appreciate it because this is a differential diagnosis I so often see, so the fact that western medicine is recognizing it as well, can then hopefully lead to a more integrated approach to care for patients like you and your little ones! Something I feel so passionate about. Woah. I just started and I’m already digressing. Okay lets dive in:
What CMA is referring to is an immune response - either a typical IgE ‘allergic’ reaction or a non IgE mediated (which is typically referring to IgG ‘food sensitivity’ reaction) to cow’s milk. I often think (yet no hard rule) of an IgE mediated symptom of immediate, urticaria, red angry rashes coming in all sorts, vomiting, acute diarrhea. Versus an IgG mediated response is a bit more low, slow, chronic - ie eczema, constipation, diarrhea (not acute), bloating, dampened immune system. As you see, there is alot of cross over, isnt there?
Cow’s milk contains multiple proteins (for example – beta casein A1 and A2, whey, bovine lactoferrin, bovine immunoglobulins) and the body can be reacting against any or all of the above. Interesting enough, heat (ie milk in baked goods) or fermented milk (ie yoghurt) is often times better tolerated as it diminishes the allergenicity of whey protein. This information is useful because if one only reacts to whey, when it comes to navigating food eliminations from diet.
CMA can appear within the first few days, weeks or months of babes life whether formula fed or breastfed. Symptoms can include eczema, urticaria, reflux (ie spitting up/vomiting), failure to thrive, abdominal pain, diarrhea, constipation, blood in stool and mucous in stool.
Often times it has been shown that children will grow out of non IgE mediated (often referred to as food sensitivities) yet sometimes persists into adolescence – more typically being IgE mediated reactions (ie allergies).
Gold standard diagnosis is a double blind oral food challenge! What does this even mean? Essentially give babe cow milk protein and see the symptoms/outcome. Sometimes cow’s milk specific IgE blood testing can aid in the diagnosis, yet not well researched if its not an IgE mediated reaction (ie more of a food sensitivity). Naturopaths are known to run IgG food sensitivity testing which is controversial
Treatment for this is to eliminate cow’s dairy for 2 – 8 weeks – so therefore put on a hydrolyzed formula, eliminate from moms diet if breastfed, and eliminate from babe’s diet if on solids. Assess symptoms.
Often times this can be an overwhelming diagnosis when sleep deprivation, unhappy child, adjusting to new life with babe/toddler is occurring, so here are some helpful points:
WHAT DOES THIS ALL MEAN AND WHAT DO WE DO ABOUT IT:
1. First we want to assess exactly what is going with respect to symptoms. This is critical because it may be that its not a CMA OR it may be that it’s a non IgE mediated CMA which can benefit from a multi-layered treatment plan. Here’s an example:
a. A 4 month old female patient walks (well, carried lol!) in the door and has been diagnosed with a CMA presenting with eczema and constipation post her 4 month vaccinations. By supporting the gut with probiotics and more importantly in this case, the liver to detox, eczema and constipation were both ameliorated in one months time and no dairy eliminated
b. A 2 week old male patient comes into clinic with a CMA diagnosis presenting with colic – gas, crying, stretching, arching, NAWT happy. For this specific case, I prescribed a constitutional homeopathic remedy for his actions, cry, and digestion picture, probiotics, as well as osteopathic treatment as he has a head tilt to the left (where the vagus nerve runs down the neck which regulates digestion). At 4 weeks old he was a new little guy
c. A 4 week old that has projectile vomiting, slow weight gain, and red rash on face. Elimination of dairy from the diet from mom who came back 2 weeks later and reported 80% improvement of rash and vomiting. Supporting mom (see point number 2 below) was an integral piece in this case. We added in vitamin D, a probiotic, castor oil belly rubs nightly, brought in support from a lactation consultant and weight gain increased, rash and vomiting was ameliorated.
2. If a CMA is present then the elimination of a food (dairy) can be overwhelming for a breastfeeding mom and child (if eating solids)! Getting a plan in place is helpful. What this entails is:
a. Understanding what dairy is in! It depends on the situation, yet we typically eliminate all kinds (cheese, milk, yoghurts and butter) whether its cooked in products or plain. That’s because then we aren’t second guessing if this is truly the issue are not.
b. Establishing a length of time can be helpful. Research suggests 2 – 8 weeks – this is quite a wide range especially if a babe is only 2 weeks old! This is decided on case by case and depends if this is IgE or non IgE mediated allergy
c. ADDING NUTRITIOUS AND DELICIOUS substances to diet!! Elimination does not mean NOT eating, it means finding GOOD fats, LOTS of protein, and GOOD nutrient dense DELICIOUS foods. THIS IS SO IMPORTANT. I’m yelling aren’t I? This is SUCH an important piece to this entire process – it should have its own blog piece due to the fact that all of the following depends on diet: growth and development of mom and babe, breast milk production, mental/emotional health, health of other body systems aside from digestion
d. Picking the correct formula along side of the dairy elimination in solid foods can be a lot – guidance through this process is key to reducing stress for mom and babe
3. Healing the gut lining: often times when babes are so young we can eliminate dairy and assess via symptoms of digestion, skin, mood, growth, the healing of the gut lining. If more support is needed, it may be that elimination of other foods are needed, soothing demulcents via mom or directly can be used, or other body systems are involved and treatment is needed in other areas aside from the gut.
Symptoms of a CMA do not always walk straight as laid out above – yet know support can be received through the whole process. Big hugs to you mamas navigating new babe’s, second, third or fourth babe’s health! Deep breaths :)
