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Cow’s Milk Allergy

What is cow’s milk allergy (CMA)?

Milk is made up of protein, sugar, fat, vitamins, minerals and water. In some children abnormal immunological reaction to cow’s milk protein occurs giving rise to a condition called cow’s milk allergy.

How common is the problem?

  • About 1% to 5% of infants are allergic to proteins found in cow’s milk and cow’s milk-based formulas
  • Most infants will outgrow milk allergies by the second or third year

How does one detect CMA?

Signs and symptoms will generally appear within the first six months of life 2 main types of reaction :

  • Rapid type which comes on suddenly with wheezing, vomiting, eruption of itchy patches on the skin (urticaria), swelling of eyes and other parts of body (angioedema) and severe whole body reaction (anaphylaxis).
  • Slower-onset reaction which is more common and symptoms include loose stools, blood in stools, vomiting, irritability, colic and poor growth.

Important to consult your doctor for a proper diagnosis as these signs and symptoms may occur in other conditions.

What are further problems that may be encountered with CMA?

Complications may occur and they include :

  • Higher associated risk of other allergic manifestations eg asthma and eczema
  • Milk-induced enteropathy resulting in failure to thrive and anaemia
  • Nutritional deficiency if not appropriately substituted with non-cow’s milk protein based formula in young infants
  • Potential fatality with anaphylaxis

How is CMA treated?

  • In severe milk allergy, medications such as epinephrine/adrenaline and anti-histamines are necessary.
  • Avoid all sources of cow’s milk completely .
  • In breast-fed babies, mothers are to avoid dairy products in mothers’ own diet.
  • In formula-fed babies, switching to a soy-protein based or hydrolysate based formula is recommended and in severe cases, an aminoacid based formula may be necessary.
  • Vitamin D and calcium supplements may be necessary if your child is not drinking an alternative milk or formula.
  • Cow’s milk may slowly be reintroduced into child’s diet after 12 to 18 months under medical supervision.

Is there a way to prevent CMA?

  • Exclusive breastfeeding for six months is encouraged in babies with a family history of allergic conditions eg asthma and eczema to delay the onset of symptoms if the child has cow’s milk allergy.
  • If formula milk is necessary hydrolysate based formula is preferable to standard formula.


  • Cross allergy between cow’s milk and soy milk occurs in some children. About 8 to 15% of rapid-onset type of cow’s milk allergy are also allergic to soy protein while more than half of late-onset type are allergic to soy protein too.
  • Read food labels and avoid foods that contain milk or any related products eg butter, cream, cheese, lactulose and foods that may contain milk protein eg chocolate, caramel candies, luncheon meat and sausages.
  • Advice from nutritionist on food contents of specific foods must be sought when uncertain.
  • Explain condition to child as he grows older to help him understand that he has to avoid foods containing cow’s milk.
Last reviewed : 26 September 2008
Content Writer : Dato’ Dr. Lim Nyok Ling
    Dr. Lim Sern Chin