Milk allergy is rare in adults and should not be confused with lactose intolerance. Milk allergy is a reaction of the immune system to the protein in milk; whereas, lactose intolerance results from the incomplete digestion of the natural sugar in milk called lactose, due to insufficient production of the enzyme lactase in the intestine. Since milk allergy and lactose intolerance are different conditions, they need to be managed differently.
Current perspective
It’s estimated that fewer than 0.5% of adults and around 2-3% of children have an allergy to cow’s milk.1 Children who experience an allergy to milk tend to outgrow it by the age of 3.1
A new way of thinking about food allergies
The thinking on when to introduce potential food allergens such as whole eggs, peanuts and cow’s milk to infants has evolved. Based on current evidence we now know that introducing these foods in the diet of infants early may actually help to prevent the development of an allergy.2
This has led to new infant feeding guidelines to help prevent food allergies. Traditionally, health authorities recommended that parents delay the introduction of certain common food allergens to infants. The previous way of thinking was that feeding infants these foods early would increase their likelihood of developing an allergy to these foods. However, newer evidence suggests that introducing potential food allergens such as whole eggs, peanuts and milk products earlier may help to reduce the likelihood of infants developing an allergy to these.1-3
Current Canadian Paediatric Society guidance
In 2019, the Canadian Paediatric Society issued new feeding guidance for infants at high risk of food allergy.3 These include infants with a personal or immediate family history of an allergic condition. For infants at high risk, the new guidance suggests introducing commonly allergenic solid foods early, at around 6 months of age (but not before 4 months), while being mindful of their developmental readiness to eat solid foods. Infants at no or low risk of food allergy should also start to eat solid foods, including commonly allergenic foods, at about 6 months.
In practice
Traditionally, health authorities recommended that parents delay the introduction of certain common food allergens such as whole eggs, peanuts and cow’s milk to infants in order to prevent a food allergy from developing. The thinking on this has evolved following newer evidence.
- Canadian Paediatric Society guidelines recommend feeding commonly allergenic foods when baby is ready to eat solid foods at around 6 months.
- When infants appear to tolerate a commonly allergenic food, it’s important to continue offering it to baby a few times a week to maintain tolerance.
- If an adverse reaction to food is suspected, parents are advised to consult their child’s doctor for professional guidance.
- Keep in mind that avoiding foods can affect children’s nutrient intakes. For example, calcium needs attention in children who avoid milk products.
When a child appears to experience an adverse reaction to food, it’s important for parents and caregivers to consult a qualified health professional to obtain a proper diagnosis as well as advice on how to manage food allergies safely and effectively. There are newer evidence-based approaches that may help to manage food allergies with health professional guidance.1-5
Remember that children tend to outgrow an allergy to cow’s milk by 3 years of age. If a child is diagnosed with a cow’s milk allergy, it’s important for parents or caregivers to consult with their child’s allergist for advice on whether they can and how to reintroduce cow’s milk. Keep in mind that special attention to nutrient intakes is needed when children avoid foods due to an allergy.
References
- Knol E et al. Management of cow’s milk allergy from an immunological perspective: what are the options? Nutrients 2019;11:2734.
- Abrams E et al. Timing of introduction of allergenic solids for infants at high risk. Canadian Paediatric Society 2019;24(1):56-57.
- Sackesen C et al. Current trends in tolerance Induction in cow’s milk allergy: from passive to proactive strategies. Frontiers in Pediatrics 2019;7:372.
- Mori F et al. Oral immunotherapy for food-allergic children: A pro-con debate. Front immunol 2021;12:636612.
- BSACI and The Canadian Society of Allergy and Clinical Immunology joint statement on oral immunotherapy. bsaci.org. Accessed March 1, 2022.
