What is Cow's Milk Protein Allergy (CMPA)?
are cMPA & reflux related?
Have you been told by your paediatrician that your baby has suspected cow's milk protein allergy, or CMPA?
Cow's milk allergy is one of the most commonly diagnosed food allergies, alongside peanut & tree nut allergies, as stated by the American Association of Pediatrics (AAP).
CMPA occurs in approximately 3% of infants aged 0-6 months, which could be IgE mediated or non-IgE mediated allergic responses. Around 60% of infants with CMPA are IgE-mediated, which occurs when the immune system reacts abnormally to a specific food protein, or proteins. While it’s predominantly affects formula-fed babies, it can also affect breastfed babies too. When you consider how many infants there are in the world, these numbers are much bigger than they look!
CMPA is mentioned a lot by health professionals and parents alike, so my aim is to help you understand what CMPA is, what symptoms you may see your little one experiencing, & how you can access support to resolve these symptoms & reduce their discomfort.
So, what is CMPA?
Cow's milk proteins, like casein & whey, are complex proteins found in dairy products such as cow's milk & are difficult for the immature infant digestive system to process. Being a complex protein, it has long chains of single protein structures, called amino acids, & these are broken down or digested by enzymes within the body at various stages. In an infant, however, these enzymes are either not produced until the gut has further matured, or they are produced only in small quantities. This makes breaking down these complex protein structures more difficult in the first few months.
When one or more of these proteins are consumed, the immune system detects them as a potential threat, causing one of 2 immunological reactions. These reactions are defined as whether or not the immune system marker Immunoglobulin E antibody, known as IgE, is present or not. These are described as an IgE-mediated response or a non-IgE-mediated response. If you want to, you can look up these 2 reactions yourself, diving into all of the research that's out there, but for the purpose of this blog post, I will keep the science to a minimum!
The incidence of CMPA in exclusively breastfed babies is lower than those that are formula-fed or have a combination of the two. Exclusively or partially breastfed babies will typically see an increase in their symptoms as cow's milk-based products are introduced to their diet, either as formula milk ingredients or when weaning onto solids.
The mother's diet can impact their consumption of these proteins too, but unless the infant is particularly sensitive to these cow's milk proteins, symptoms are usually mild to moderate in comparison & can be reduced through a change in the mother's diet.
There are 2 potential types of CMPA:
As mentioned above, there are 2 different types of CMPA that can occur based on the individual’s immune system response. The IgE-mediated response is a more immediate, faster response; however, a non-IgE mediated response is a delayed, slower response. The signs & symptoms your baby is experiencing can help us identify which type of allergy reaction is most likely.
1. Immediate CMPA - symptoms will typically appear within minutes of consuming milk proteins, but usually less than 2 hours
~ Symptoms are usually skin changes, reflux, blood in the stools & digestive/gut symptoms
~ If severe enough, anaphylaxis can occur with a strong allergic reaction, especially in children that also have asthma
2. Delayed CMPA - symptoms can appear several hours, or even days, later
~ Symptoms are usually in the lower half of the digestive system, causing trapped wind, pain or diarrhoea, & can cause skin changes or respiratory symptoms too
~ Can be mistaken for lactose intolerance
There’s an important thing to note here: lactose intolerance is not the same as CMPA. What makes it a different reaction is the role of the immune system. In a true allergic reaction, the immune system is involved regardless of which response it is.
What symptoms might you see?
Your baby may develop signs & symptoms such as these listed below, varying in frequency & severity based on how sensitive their immune & digestive systems are to these proteins. Typically, the more that is consumed, the greater the body's response & the worse the symptoms become; however, what type of immune response the body has will impact this too.
🌻 Skin changes, including rashes, hives, eczema that can come on soon after feeding & lasts longer than expected
🌻 Increased/projectile vomiting or diarrhoea, where the body is trying to rapidly expel the allergen from the body, which can mimic increased reflux symptoms
🌻 Crying in pain that is worse after eating, making it harder to soothe & settle them
🌻 Digestive or gastrointestinal (GI) discomfort, like bloating or sore tummy, constipation & trapped gas, often caused by irritation & inflammation in the gut as the body has to allow the proteins to pass through the entire digestive system before they can be expelled - blood in their stools can often be seen too if there is damaged gut tissue from these symptoms
🌻 Cold-like symptoms, including runny or blocked nose, sneezing & chronic congestion
🌻 Respiratory symptoms, such as wheezing & coughing
How can it be diagnosed?
A true milk allergy triggers the body's immune system, causing it to put up it's defences in an attempt to protect itself from potential damage that an allergen (in this case the milk proteins) may cause when they are consumed.
If it is a true allergic response, this can only be diagnosed by a qualified specialist in allergies, so it is important to ask your doctor or paediatrician for referral to the appropriate physician or specialist if CMPA is suspected.
As a parent, what can I do for my baby?
Removing CMP from an infant's diet will allow their gut to begin to heal, the inflammation to subside & the discomfort can ease. An infant's gut can begin to heal relatively quickly once the culprit is removed, with symptoms usually improving within 5-7 days - great news for your baby's pain and symptoms!
If your baby is on formula milk, be it exclusively or partially, it may be that one or more of the ingredients are triggering their symptoms. It is important to find the best formula milk choice for your little one that eliminates the identified allergens to allow the digestive & immune systems time to calm so that the body can take time to heal itself. There are specialised formula milks advertised as 'hypoallergenic' or 'hydrolysed' milks, even 'amino acid-based' formulas, but it is important to find the one that best suits your baby's reactivity & nutritional needs. Involving a dietician should be considered to establish your child is getting sufficient nutrition to maintain their daily nutritional requirements during their development.
How can I help?
You may be concerned about the symptoms your baby is experiencing, but many of the signs of discomfort from a food sensitivity can be related to, or overlap with, infant reflux. As a certified infant reflux specialist, I can help you establish if your baby's symptoms are indicative of an allergy, intolerance or something else. I have also taken additional courses for professionals in navigating infant food reactivities so I can better support the families I see.
We must identify the underlying causes of their symptoms, work out when & what symptoms they are experiencing, if there is a pattern to be found to indicate CMPA or something else, & work on strategies to resolve them quickly & effectively.
If you are unsure if your baby's symptoms are from CMPA, get in touch & we can have a free chat about what is going on & how I can help. You are not alone during this challenging & stressful time.
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If you would like my help, you can email me, download my free reflux symptom tracker, check out my social media pages, or see my posts on oral ties
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Please note - this content is intended for an educational purpose & should not be taken as medical advice.
You are encouraged to seek medical advice if you are concerned about any symptoms your baby may have.