By Dr Nandan Joshi
Food allergy is a growing healthcare issue. It can be understood as an adverse response by a body to certain food items. People who suffer from food allergies face a situation where their immune system wrongly recognises certain food components as harmful leading to a negative response from the body. These reactions present with symptoms like diarrhea, wheezing, skin rash and sometimes result in life threatening situations like anaphylaxis. Out of all the food allergies that a baby may experience, Cow’s Milk Protein Allergy (CMPA) is the most common among children. Almost three in 100 children experience it typically before their first birthday.
CMPA is often confused with lactose intolerance which prevents its timely diagnosis and impedes treatment. CMPA is a type of milk allergy where a baby is allergic to the protein present in cow’s milk. The whole of gamut of symptoms that a baby experiences includes skin rashes (swollen pale red bumps or plaques on skin), digestive issues (diarrhea, vomiting, constipation) and respiratory problems (difficulty in breathing, coughing, runny nose). A meagre quantity of cow’s milk can trigger a reaction from the body. On the other hand, lactose intolerance is defined as the body’s inability to digest the milk sugar which is called lactose. The concomitant symptoms include bloating, abdominal pain, flatulence or diarrhea. Apart from the physiological difference in the impact, CMPA usually happens in children, though most grow out of this phase before they turn five years of age, while lactose intolerance is found in adults as well.
Due to the presence of equivocal symptoms, the diagnosis of Cow’s Milk Protein Allergy becomes difficult. It is easy to confuse it with lactose intolerance as the initial symptoms mirror each other. A correct diagnosis allows the appropriate treatment to be given to infants. The gold standard for diagnosis is elimination followed by an oral food challenge. The symptoms should disappear after eliminating cow milk and milk products and after re-introduction of cow’s milk the symptoms should re-appear. The management of cow’s milk protein allergy is defined on the basis of the severity of symptoms. A substitute formula is needed to fulfill nutritional requirements of a child with CMPA and the best choice of such a formula depends mostly on the age of the patient and the presence of other food allergies. For infants who are less than six months old, exclusive breastfeeding should be the first choice and if the symptoms persist despite exclusive breastfeeding, then the mother needs to eliminate all cow’s milk products from her diet. For babies who are on complementary feeding, administration of amino acid-based formulas or extensively hydrolysed formula is an option.
There is a need to create awareness about the Cow’s Milk Protein Allergy since it is easy to confuse it with lactose intolerance. Timely diagnosis and treatment will help to alleviate its symptoms and aid in management of this disease so that the baby can lead a healthy life.
(The writer is Head, Nutrition Science & Medical Affairs, Danone India.)