Cow’s milk protein allergy (CMPA) is the first food allergy to appear in children and affects around 2.5% of children aged under 14 all over the world. While it tends to disappear before the age of 3 in 90% of cases, this disease can cause different skin, gastrointestinal or, more rarely, respiratory reactions.
Fortunately, there are solutions to circumvent it, such as replacing allergenic proteins with protein hydrolysates.
What is cow’s milk protein allergy ?
Cow’s milk protein allergy, or CMPA, is not a milk allergy.
As its name suggests, it appears in response to proteins that make up approximately 3.5% of cow’s milk.
What is the difference with lactose intolerance?
Cow’s milk protein allergy has nothing to do with lactose intolerance.
|Lactose intolerance||Allergy to milk proteins|
|Affected population||Adults mainly||Mainly infants and children under the age of 3|
Poor digestion of lactose often because of a lactase deficiency, which allows the fractionation of lactose in order to better digest it
|Triggering an immune response against milk proteins|
Most vulnerable: infants and young children
Although it may also affect adults, CMPA mainly concerns children under the age of 3. Most often, it occurs in the first few months of the life of infants.
The order in which CMPA symptoms manifest themselves makes it possible to distinguish two distinct clinical tables:
- Immediate manifestations, which occur within 2 hours after drinking the bottles, are associated with the production of IgE antibodies (IgE allergy mediated)
- Delayed manifestations, which may take several days to appear. This is referred to as a non-mediated CMPA. These allergies are caused by immune system cell reactions against milk proteins, without IgE antibody intervention
There are multiple CMPA symptoms.
|Skin manifestations||Redness, itching and swelling||50% of children with CMPA|
Vomiting, colic and GERD (gastroesophageal reflux)
Blood in stools
Interruption or decline in growth curve
|25 to 50% of children with CMPA|
|Respiratory manifestations||Wheezing, asthma||Rare|
What is the cause ?
While beta lactoglobulin has long been considered the main culprit in causing CMPA, more recent studies now also point to caseins.
Solutions to get around cow’s milk protein allergy
Milk proteins are essential for feeding infants and young children, which is why there are alternatives, which may be prescribed by pediatricians depending on the severity of the allergy.3
First-line solution: Milk protein hydrolysates (MPHs)
Protein hydrolysates are obtained by hydrolysis of cow’s milk proteins.
Hydrolysis consists of cutting proteins at the peptide bonds, in order to obtain smaller molecules.
MPHs thus contain peptides smaller than 2000 Daltons, improving their digestibility and reducing their allergenicity.4
These hydrolysate-based formulations are offered by several infant milk brands on the market.5
Amino acid-based formulas
In 10% of children with CMPA, some symptoms may persist despite the use of hydrolysates.3
An alternative solution is to further reduce the size of the molecules so that they are not recognized by the child’s immune system.
Amino acid-based formulations may then be prescribed by a healthcare professional.
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 Antibody= Immunoglobulin E, or IGE