Cow’s Milk Protein Allergy (CMPA) is a common food allergy among young children and infants, and its prevalence in Malaysia is comparable to that of Western countries.

It happens when an infant or child’s body responds to cow’s milk protein with a hypersensitive allergic reaction. It is estimated that between 2%-7.5% of infants suffer from CMPA.

Even exclusively breastfed infants who have CMPA can be affected as cow’s milk protein may be transmitted via breast milk – in such a situation, the mother would have to eliminate cow’s milk from her diet.

While CMPA can develop from the neonatal period, it tends to peak by the first year of life and usually resolves by around three to four years of age.

The rate that your child outgrows CMPA is roughly between 45%-50% for one-year-olds, 60%-75% for two-year-olds, and 85%-90% for three-year-olds.

However, there are cases where CMPA persists into adolescence.

Identifying CMPA

As the signs and symptoms associated with CMPA can be unclear at times, you should keep a close eye on your infant.

Here’s what you need to stay alert for:

General: Persistent distress or colic (baby is irritable or cries for three hours or more daily) occurring at least three days per week for more than three weeks.

Skin: Atopic dermatitis (dry, scaly patches on the skin), angiooedema (lips or eyes/eye lids become swollen) and urticaria (hives) that occur for no other reason, e.g. infections, medicines or other causes.

Gastrointestinal: Frequent regurgitation, vomiting, diarrhoea, constipation (with/without perianal rash), blood in stool and iron-deficiency anaemia.

Respiratory tract: Runny nose, chronic cough and wheezing.

Diagnosing CMPA

The most commonly used method to reliably diagnose CMPA is by eliminating foods that contain cow’s milk protein from your infant’s diet.

If he is exclusively breastfed and has not started complementary feeding yet, then the elimination diet would also apply to the breastfeeding mother.

This means removing all sources of cows’ milk protein in mother’s diet, in order to prevent the protein from any cow’s milk in her diet being transferred to baby via her breast milk.

If his symptoms improve, then foods with cow’s milk protein can be re-introduced to see if a reaction re-occurs.

This should only be carried out under the guidance of healthcare professionals as proper knowledge of how to achieve the elimination diet is critical for success.

They will be better able to advise you on important points such as accidental exposure and cross-contamination (e.g. shared utensils, cups, or plates), and also advise you on what to watch out for when shopping for food products.

Did you know?

Allergies, CMPA, cow's milk, skin prick test, Star2.com

CMPA can lead to various general, skin, gastrointestinal and respiratory tract symptoms. You can test for it through the skin prick test.

Foods that contain cows’ milk include (but are not limited to) items such as butter, buttermilk, cheese, cream cheese, lactose, milk (evaporated, powder, condensed), cream, sour cream, ghee, curd, and also food products that contain whey or whey solids, milk solids, hydrolysed whey, whey powder or yoghurt.

As food manufacturers may change the ingredients they use at any time, make it a point to check the ingredients list before you buy any food product.

As dairy foods are one of the best sources for calcium, you will need to eat other foods that are rich in calcium such as canned sardines, anchovies, beans and bean products (e.g. yellow dhal), tofu, tempeh (fermented soybeans), and vegetables such as spinach, watercress, mustard leaves, cekur manis, tapioca leaves, kailan and broccoli.

You can also opt for breakfast cereals, biscuits, and even rice, that are enriched with calcium.

If you want to take supplements instead, do check with your healthcare professional to see what he or she recommends.

However, in the event that there is no improvement in baby’s symptoms despite the elimination diet, your baby’s paediatrician will need to run further diagnostic tests to find the cause.

Clinical tests

Such tests include:

• Blood test (radioallergosorbent test, or RAST) – This test is used to look for allergens and can be used to check for milk protein antibodies known as Immunoglobulin E (IgE).

However, if your infant suffers from a non-IgE CMPA, this test would give a negative result.

• Skin Prick Test – A small droplet with the suspected allergen is placed on the skin, which is then scratched or pricked with a needle.

If a wheal appears, i.e. the skin turns red with a raised itchy area, it is a positive reaction and means that your infant is allergic to that allergen.

Do note that it is possible for allergies to appear as either just one particular type of allergy, or as a mixture of IgE and non-IgE allergies.

Anaphylaxis

You may have heard of anaphylaxis, or anaphylactic shock. It is a situation when the patient’s body has a severe, and quite possibly life-threatening, reaction to a specific allergen, including, but not limited to CMPA.

Luckily, not all CMPA patients will suffer from anaphylaxis. However, as many as 9% of CMPA patients may exhibit anaphylaxis, so make sure to keep an eye on your infant or toddler, especially if you already suspect that he may have CMPA.

If his body reacts to the allergen (in this case, cow’s milk protein) with a severe allergic reaction, it should be treated as a medical emergency.

These allergic reactions tend to be severe and immediate, and can affect more than one organ.

It is a serious and potentially life-threatening symptom as it could cause the airway to narrow or swell shut, or even lead to a drop in blood pressure that can lead to shock.


Dr Amir Hamzah Abdul Latiff is a consultant paediatrician and clinical immunologist/allergist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.