Immune-mediated allergic response to milk proteins.
a) Immunoglobulin E (IgE)-mediated. It has following characteristics
  • Acute and rapid onset.
  • Up to 2 hours after ingestion of cows’ milk.
  • 50% children become milk tolerant by 5 years.


b) Non-IgE-mediated reactions. It has following characteristics-

  • Delayed and non-acute allergic response.
  • Can occur up to 48 hours or even 1 week after ingestion.
  • Most children become milk tolerant by 3 to 4 years.



a) Skin reactions
  • Pruritus/ Erythema
  • Atopic eczema
  • Acute angioedema


b) Gastrointestinal symptoms
  • Nausea/ Vomiting
  • Colicky abdominal pain
  • Diarrhoea/ Blood in stool
  • Reflux / Constipation.


c) Respiratory tract symptoms

  • Cough/ wheezing
  • Nasal itching/ sneezing/ rhinorrhoea


d) Failure to thrive



  • Lactose intolerance
  • Other food allergies- (hens’ eggs, soy, wheat)
  • Anatomical abnormalities (Meckel’s diverticulum).
  • Gastro-oesophageal reflux disease
  • Crohn’s disease / Coeliac disease/ Ulcerative colitis
  • Constipation/ Gastroenteritis
  • Pancreatic insufficiency ( cystic fibrosis).
  • Infections (urinary tract infections)



  • Clinical examination.
  • Trial elimination of cow’s’ milk for 2–6 weeks, followed by reintroduction
  • Skin prick test (Positive only in IgE mediated reactions)
  • Blood tests for antibody levels to milk proteins.



In Exclusively breastfed babies –

  • Mother to exclude cow’s’ milk protein from her diet.
  • Supplement 1000 mg of calcium + 10 micrograms of vitamin D to mother on daily basis.


In formula-fed babies-

Use hypoallergenic formula
Treat for at least 3 weeks to see improvement.
Names of common hypoallergenic formulas are as below-
a) Extensively hydrolysed formulas ( 1st line of treatment).
  • Alimentum— can be given from birth
  • Aptamil Pepti 1 — can be given from birth
  • Aptamil Pepti 2—given  from 6 months of age
  • Cow & Gate PeptiJunior — given from birth
  • Nutramigen Lipil 1 — given from birth
  • Nutramigen Lipil 2 – given from 6 months of age
  • Pregestimil Lipil— given from birth


b) Amino acid formulas – the Second line of treatment.

These are more expensive than hydrolysed formulas.

  • Neocate LCP — given from birth
  • Neocate Active — given from 1 year of age
  • Neocate Advance — given from 1 year of age for children who cannot eat any other foods
  • Nutramigen Puramino — given from birth



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