When Sharon Sim, 34, gave her 16-month-old son cow's milk, she had the shock of her life. Within 15 minutes, he had become very quiet and she could sense his discomfort. He started to scratch his throat area and then threw up. His face began to swell and turn red.
A severe allergic reaction was the last thing she had expected because he had previously enjoyed the milk so much that she even had to stop him from drinking more. "We didn't expect such a serious and immediate reaction. But after throwing up, he became all right and we could see that he felt much better," says Sharon. She then called her paediatrician, who advised her to take him for an allergy test. She took him for a skin prick test that confirmed he was allergic to milk and dairy products.
Milk is one of the most common food allergens for children, explains Dr Pedro Alarcon, Medical Director of the Paediatric Nutritionals of the Abbott Nutrition International. In fact, studies in several countries around the world show a significant prevalence of milk allergy in children in the first year of life.
A questionnaire survey conducted here on over 5000 children revealed that the vast majority of 4-5% of the children who had allergies, had a mild allergy to dairy. For severe allergic reactions, the hospital has only seen a couple of children over the last five years. But milk is food most children would be able to tolerate, explain Dr Lynette Shek, Consultant in the Department of Paediatrics, Children's Medical Institute, National University Hospital and Assistant Professor Yong Loo Lin of the Department of Paediatrics, School of Medicine, National University of Singapore. "Babies rely on milk for their food, especially breast milk. But cow's milk is a foreign type of food, and that's the reason why there is such a thing as a milk allergy. It is the "foreign protein" found in cow's milk which triggers these reactions."
A milk allergy is when a child responds with a reaction to milk. The most common reactions include rashes around the face, eyes or on their bodies. Some children may get slightly worse reactions like diarrhoea, bloatedness, blood in stools, and even eczema (a dry scaly itchy skin rash) and breathing problems. "Even though a milk allergy is rarely fatal, parents do need to be aware when the child develops breathing problems", advises Dr Shek. "This happens because the throat closes and the baby has difficulty getting air into his lungs. Sometimes, they may get anaphylaxis. That's a severe reaction that affects the airways (the breathing), or blood circulation system, such that not enough blood can be carried to the rest of the body".
A milk allergy happens because of a genetic predisposition or a family history of such allergies, or when mum has introduced the foreign protein - milk at too early an age, before six months old. At that young age, the baby's immune system is not mature enough to handle the foreign protein. Dr Shek advises mums of babies with a strong family history of allergies - for example, if the older siblings have milk allergies - to prolong breastfeeding as much as possible and to delay the introduction of milk, even beyond the first birthday.
For babies with allergies, the American Academy of Paediatrics (AAP) recommends breast milk as the best food for babies. "Babies are meant to drink milk for food. Breast milk is their normal food and breast milk allergy should not occur," says Dr Shek. But babies can develop reactions to certain components found in breast milk because the food allergens which mum eats can get into her milk. "It is the foreign protein found in breast milk and not breast milk itself which causes these reactions. If your breastfed baby develops a reaction, then you should consider what you have eaten. For example, you may have eaten eggs, peanuts, milk, or fish. These are highly allergycausing food. Try to avoid these foods. If it is still not clear what has caused the reaction, consult a doctor because there are more allergy testing which can be done," explains Dr Shek.
Sharon realised this only when she stopped consuming dairy while nursing her son. When she eliminated dairy, her son's eczema soon cleared up. This made her realise that her consumption of dairy, while nursing him when he was a baby, probably triggered his eczema. It was not due to family history as she had earlier thought.
For infants with allergies, the AAP recommends that nursing mums eliminate peanuts, tree nuts (eg, almonds, walnuts, etc) and other foods like eggs, cow's milk and fish from their diets. These infants should also not be offered solid foods until they are 6 months old. Delay the introduction of dairy products till the baby is one year old, eggs two years old and peanuts, nuts and fish till he is three years old.
If your child is on formula and has been confirmed to have a milk allergy, he can be offered a soy alternative. "The development of soy formulas grew out of the need for a non-milk-based formula alternative for infants who had allergy or intolerance to cow's milk formulas. For example, Isomil Follow Up, a soy formula, offers equivalent nutritional benefits as extensively hydrolyzed formulas, but is often cheaper and more palatable," advises Dr Alarcon. In fact, the AAP states that soy formula is a safe and effective alternative that provides appropriate nutrition for normal growth and development.
In addition, soybased infant formulas have a long history of safe use in the United States and around the world. "Soy formulas have been shown to be effective in supporting weight, length and head circumference growth similar to cow's milk-based formulas. These findings were consistent with the US National Centre for Health Statistics' reference data. Clinical evidence also shows that switching to soy will substantially reduce common feeding problems (ie, spit-up/ colic caused by intolerance to cow's milk-based formulas) in over 80% of babies in three days," says Dr Alarcon.
But Dr Shek warns that 20% of children with a milk allergy, may also be allergic to soy. "For children with severe allergy reactions, I would advise parents not to let them try soy before getting an allergy test done; and only introduce it under supervision. If they are also allergic to soy, then a special elemental formula can be prescribed." Dr Shek also explains that it is a common fallacy that goat's milk is a suitable replacement because goat's milk is 90% similar to cow's milk. "If someone is allergic to cow's milk, he will most likely be allergic to goat's milk as well. Goat's milk is still foreign and the proteins that cause allergies are found in both cow and goat's milk," says Dr Shek.
Dr Shek advises parents to seek medical attention first before making any drastic changes, especially if they are unsure if their child really has a milk allergy. "If the reaction is extensive, anything beyond a few bumps, or if you are thinking of changing your own diet drastically while breastfeeding, or changing formula, or if you are just worried, then it's best to see a doctor first." She uses the classic peanut allergy example to illustrate the importance of confirming severe food allergies - the first reaction could be a rash, the next reaction could be death.
Subsequent allergic reactions usually get worse and so parents need to know what food their child is allergic to. Another reason for an accurate diagnosis is for parents to know how to deal with bad allergic reactions as "foreign protein" can be found almost everywhere, for example, milk can be found in biscuits or bread etc.
Sharon knows that and is not taking any chances. Her son has an emergency kit that is always with him in case of accidental ingestion. He brings his own snacks to school. His parents also pack food for him when they go out to meet friends or attend parties. They always read food labels when grocery shopping. "We just have to educate him constantly about how he is not to take food from others. He seems to understand now but it may become more difficult as he grows older. Cakes and ice creams can be rather tempting and he may think "surely, it can't be that bad if all my classmates are eating them," says Sharon.
The majority of these children will outgrow the condition. Based on Western studies, 80% will outgrow it by the age of 3 years and more than 95% by the age of 5 years. A child with a milk allergy will also not grow up to be a lactose-intolerant adult either. "There is no association between the two. As we grow older, we lose the enzymes needed to breakdown the lactose. Lactose in intestines will cause bloatedness and some abdominal discomfort. This is not the same as an allergic reaction," explains Dr Shek. So Sharon remains hopeful that one day her son will also outgrow his allergies, but in the meantime, she just has to manage his allergies the best way she can.
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