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Who’s who in cow’s milk allergy?

The lowdown

Cow’s milk allergy (also known as cow’s milk protein allergy or CMPA) is an abnormal response by the body’s immune system in which proteins in cow’s milk are seen as a potential threat. This can cause the immune system to be’sensitised’, which means there is the potential that when cow’s milk is consumed, the immune system remembers this protein and reacts to it by producing allergic symptoms, which can happen immediately after feeding or at a later time (identified as a delayed reaction).

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There are two types of cow’s milk allergy, depending on how the immune system reacts. Symptoms that are immediate are caused by the immunoglobulin E antibody, IgE, whereas the other type of milk allergy happens when symptoms are delayed and are caused by a different part of the immune system reacting in a different way. This is known as a non-IgE mediated allergy and is the most common type. Symptoms typically develop from two hours after consumption but can take up to 72 hours to occur.

Cow’s milk allergy is common in infants and very young children but rarely develops after one year of age. This is because the onset of cow’s milk allergy is closely related to the introduction of cow’s milk-based infant formula. Whilst cow’s milk allergy is one of the most common food allergies to affect babies and young children in the UK, it is still pretty rare, with one in 50 children under one years old being affected. Plus, half of the children affected by the allergy will outgrow it by one year and most will have outgrown it by the time they turn three. However, in a small minority of people, cow’s milk allergy may be lifelong and severe.

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Cow’s milk intolerance

Whilst some reactions to cows’ milk involves the immune system, others are caused by difficulties digesting the milk, which is known as cow’s milk intolerance. Patients usually have gut symptoms such as vomiting, diarrhoea and colic, but unlike the allergy, intolerance does not typically cause eczema, hives or breathing difficulties and strict milk avoidance is not necessary. Symptoms of cow’s milk intolerance can develop over hours or days after ingesting cow’s milk. In medicine, the term cow’s milk allergy is only used to describe those reactions involving the immune system.

The statistics

  • The UK has some of the highest prevalence rates of allergic conditions in the world, with over 20% of the population affected by one or more allergic disorder
  • The number of allergy sufferers is on the rise
  • Almost half of the sufferers have more than one allergy
  • Allergic diseases across all ages cost the NHS an estimated Œ£900 million a year and represent 10% of the GP prescribing budget
  • Only about one in three children presenting with cow’s milk allergy symptoms is confirmed to be allergic
  • Cow’s milk allergy is thought to affect between 1.8% and 7.5% of infants in the first year of life
  • It’s the most common cause of food allergy in children
  • Prevalence is lower in breastfed infants at 0.5%
  • Cow’s milk accounts for 10%-19% of food-induced anaphylaxis cases in paediatric and mixed-age populations
  • It is the third most common food product to cause anaphylaxis, following peanut and tree nuts

Symptoms and diagnosis

Symptoms often start in the early weeks and months of life and they can affect one or more of the body’s systems, including skin, digestive, and breathing or blood circulation. Some of these symptoms, such as reflux, colic and constipation, are commonly seen in this young age group. Typical symptoms in early infancy are tummy pain and vomiting, but symptoms can sometimes include:

  • Hives
  • Swelling of the face
  • Eczema
  • Coughing
  • Wheezing or difficulty breathing

As the child gets older, allergic symptoms can include abdominal cramps, vomiting and diarrhoea, rashes, hives, redness around the mouth which can spread all over the body, a runny nose, sneezing and itchy eyes, coughing, choking, gagging, wheezing and trouble breathing. In severe cases, the reaction can develop into anaphylaxis. GPs are usually responsible for diagnosis and providing ongoing care in mild to moderate cases, with the support of a dietitian. However, suspected severe Non-IgE mediated and all immediate onset IgE milk allergies are usually referred to allergy specialists.

Treatment

Most children grow out of this allergy in early childhood, but until that happens, GPs and dietitians will work closely with the patient and their parents to ensure the child remains healthy whilst excluding cow’s milk from their diet. They will usually be assessed every six to 12 months to see if they have grown out of their allergy. If they don’t grow out of it, most people with CMPA find that antihistamines such as loratadine and cetirizine can treat their symptoms. However, if breathing difficulties or anaphylaxis has been diagnosed, they should also carry an adrenaline autoinjector such as an EpiPen with them at all times.

Who treats it?

When someone is diagnosed with CMPA, depending on the severity, they will be advised and treated by their GP, dietitians, paediatricians, and/or allergy specialists:

Allergy specialists

Allergy specialists are doctors specifically trained in the diagnosis, treatment and management of allergies. They deal with a wide range of disorders, from food allergies to anaphylaxis and run immunotherapy clinics, anti-IgE clinics, and transition clinics for adolescents. There are just 19 allergists in England, five of whom are on the GKA panel.

Respiratory Specialists

Due to this low number of allergists in England, patients may be referred to respiratory specialists, who are specifically trained in conditions affecting the respiratory system, which includes the nose, throat, larynx, windpipe, lungs, and diaphragm. They treat a range of conditions including asthma, breathing-related sleep disorders, pneumonia, sleep apnoea and more. At GKA, we have over 450 HCPs working in respiratory medicine.

Paediatricians

With the number of children suffering from allergic disease increasing each year, paediatricians are a vital member of the CMPA team. They have additional training in the field of paediatrics and will work with other medical professionals to diagnose and treat childhood allergies such as cow’s milk allergy. There are around 7,500 paediatricians in England, and at GKA, we have 192 on our panel.

Dietitians

Dietitians play an incredibly important role in the successful management of cow’s milk allergy; they help parents find formula alternatives, as well as advise on weaning. They will also develop a food and nutrition plan to ensure the patient has a balanced diet and maintains a healthy weight.

Our experience 

GKA have conducted 25 healthcare fieldwork recruitment projects in recent years on allergies, infant feeding and nutrition, recruiting across a range of methodologies including central location, online, telephone and online groups. The range of respondents types we have recruited includes Paediatricians, Paediatric Dieticians, Dieticians, Nutrition Specialists, Health Visitors, Midwives and consumers using a range of infant products. Currently, on our panel, we have 152 Dieticians and 192 Paediatricians. So, if you’re looking to conduct a market research study on cow’s milk allergy, you can rest assured that GKA have the right respondents for you.

If you have been asked to conduct a medical fieldwork project on cow’s milk allergy, why not download our panel book to find out more about the type of respondents we can access for your research.