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Every parent/carer of a newborn has natural instincts. Be it your first or fifth baby, you will instinctively know if there is something that is causing pain or irritation. Diagnosis of CMPA can be difficult. It helps to be aware of the symptoms to assist the health professionals in reaching a diagnosis.
There are many symptoms a baby may suffer from when reacting to cow's milk protein, and the problem with diagnosing CMPA is that they are very common ailments, and often not linked to CMP in the first instance.
Each baby is different and may present with one or a number of different symptoms in more than one area.
There are three main areas that symptoms will develop, these are:-
- Stomach problems (gastrointestinal)
- Breathing problems (respiratory)
- Skin problems (dermatological)
Symptoms can develop very quickly, during or shortly after consumption (an IgE allergy), or delayed over several hours & even days (non-IgE allergy).
Although more commonly in formula fed babies, symptoms can, and do, present in breast fed babies too. They will usually present in the first weeks or months of life, but a worsening of symptoms when trailed on or changed to formula milk can often be a good indication that allergy is present, even if there have only been mild or no symptoms when exclusively breastfed previously.
What are the symptoms of CMP and other food allergies?
- Vomiting (with or without blood)
- Stomach pain
- Mucousy or Bloody Stools
- Distended Stomach
- Sore Throat
- Persistent Runny Nose &/or Eyes
- Ear Ache
- Persistent Cough
- Oral Irritation (itchy mouth, excessive dribble)
- Rashes (skin and nappy)
- Hives (nettle sting type rash)
- Contact Dermatitis
- Swelling of the eyes and lips or the whole face or localised swellings (angioedema)
- Colic symptoms, excessive crying, general inability to settle.
- In some delayed diagnosis cases slow weight gain & growth.
- In rare cases an anaphylactic reaction can occur - immediate medical care should be sought!
What should you do if you think your child might have CMPA?
Medical Diagnosis of CMPA is not easy and can take time, especially if presented by a breastfeeding mother as it is less common, and as no cow's milk is entering the infant directly it is often over looked.
If you think your child may have a milk allergy talk to your Health Visitor and your GP about your concerns and discuss ways of reaching a diagnosis.
If you encounter difficulties or do not feel you are being taken seriously by your GP or Health Visitor, there are guidelines produced by the National Institute for Health and Clinical Excellence (NICE) that are there to help medical professionals and patients alike. To download the Guidelines for Childhood Food Allergies, click on the NHS NICE image above.
The MAP guidelines were written in October 2013 by Venter C, Brown T, Shah N, Walsh J, Fox AT, to assist GPs further in diagnosing CMPA specifically, The Algorithm will help your GP to understand if your baby is potentially suffering with CMPA and how to proceed with the diagnosis and management of the allergy. You can download the MAP guidelines Algorithm here.
What is the difference between an Allergy and an Intolerance?
Food Intolerance is much more common than Food Allergy, and is the less serious of the two conditions, but some of the symptoms are very similar. An allergy involves an immune reaction, whereas intolerance does not involve the body's immune system.
Allergy is caused by the body recognising a protein (in the case of cow's milk Casein & Whey) as a foreign substance and can either trigger an immune system reaction where the body produces Immunoglobulin E, an antibody to fight off the protein (IgE mediated response) or a GI Mucosal immune system reaction, where the gastrointestinal mucous fights to stop the allergens in the gut (non-IgE mediated response.) A severe allergy can be fatal. Food allergies can result in a reaction from any amount of food protein entering the body, in some very severe allergies, a reaction can occur simply by being close to the allergen, touching something an allergen has been in contact with or inhalation (including during the cooking process).
Intolerance is caused by a person's body being unable to digest certain chemicals/proteins/carbohydrates found naturally in foods and less commonly to colourings/additives/preservatives that are added to foods e.g. sulphites & nitrates, due to insufficient or complete lack of certain enzymes required in the digestion process. Intolerances causes uncomfortable symptoms like diarrhoea, bloating and wind, but can not be fatal. A person with food intolerance would normally have a limit at which their intake of a certain food would breach their tolerance level, so they may be able to consume the food in small quantities or in certain forms (for example baked milk in cakes) but not others.
It is possible to have either type of allergy (IgE or non-IgE or mixed IgE/non IgE) to one or all of the proteins found in milk - the management of each is the same, complete avoidance of cows milk protein.
Primary Lactose Intolerance (Congenital Lactase Deficiency) in babies is very rare. It occurs when a baby's body doesn't produce any or enough of the enzyme 'Lactase' which breaks down lactose, the carbohydrate or "milk sugar" found in all mammals’ milk, including human breast milk.
Secondary Lactose Intolerance is a temporary form of lactose intolerance due to a digestive disease (such as gastroenteritis) or injury (including damaged from CMPA) and can resolve once healed.
Undigested lactose causes uncomfortable symptoms like diarrhoea (often acidic,) bloating and wind, and in some cases can cause eczema flare ups. As the symptoms are similar it is easy to mistake a milk protein allergy for lactose intolerance or vice versa.
A blood test, stool acidity test or breath test can help diagnose Lactose Intolerance - breath tests will usually be done during a day admission in hospital under either an Allergist or Gastrointestinal Paediatrician.