Pages Menu

Column originally published Jan 26, 2000

Cows Milk Allergy Can Cause Repeated Spitting And Other Symptoms

Question: Our son is five months old. He was always cranky ever since he was born. I was not able to nurse him, and put him on a cows milk formula. He gained weight well, but he was always very spitty, so much so that I hate to hold him because the smell of his spit ruins my clothes. When I took him to see our doctor several weeks ago, he suggested that reflux could be a problem. But just in case if our son has cows milk allergy, he told us to change to soy formula. To my surprise, within a few days, we saw improvement already. Now he doesn’t spit, and he is much more content. Can this be possible?


Yes, this is entirely possible. Your doctor was correct when he suggested that you give soy formula a try. You son’s problem was due to cows milk allergy.

In general, whenever we talk about food allergy, most people will associate this with peanut or shellfish allergy. This type of allergy is usually very severe. When exposed to even a tiny amount of the food, these allergic people can develop swelling of the face, lips, eyes, and tongue. Their breathing can also be affected, and in the most severe situation, they can die from shock. This is called anaphylaxis.

This type of serious food allergy is caused by a special kind of antibody in the blood, which is called IgE. The reaction is often very fast, happening within minutes after ingestion of the food. Because of the seriousness of the condition, people with peanut or shellfish allergies often need to carry indictable adrenaline with them wherever they go, just in case if they eat the food unknowingly.

Cows milk allergy, on the other hand, happens rather gradually. The symptoms can be quite variable, and can mimic many other medical conditions. As a result, it is often difficult to diagnose, unless the doctor is thinking about the possibility.

The most common form of cows milk allergy is eczema. Of course, there are many causes of eczema, and cows milk allergy is just one of them. In this situation, the skin is usually very dry, especially in the arms and legs. One important place to check for dry skin is behind the ears. These children can also develop rashes on the face, torso, and extremities. Sometimes the rash can be quite red, with a rough dry surface. When it is severe, the skin can even break down at the creases of the arms and legs, which is very irritating for the child.

Cows milk allergy can also affect the intestinal tract. These children can have cramps, which will make them irritable. Some will develop vomiting or diarrhoea. The vomiting may or may not be forceful. Very often, parents will comment that their children spit up curdled milk with a strong smell, often mixed with some mucus.

Occasionally, cows milk allergy can be severe, causing swelling of the intestines, and reduce the child’s ability to digest and absorb nutrition. Blood and albumin can also leak through the intestinal wall, leading to severe diarrhoea. Parents of these children may see fresh blood mixed in with diarrhoea stools in the diapers. As a result, these children can become quite ill, with low haemoglobin, albumin, and protein in their blood. They will look pale, irritable, and lethargic, with swelling around their eyes. This is an urgent medical problem. If not treated promptly, their life can be in danger.

Cows milk allergy can also affect some children with asthma. You may have already heard that dust, mildew, animal dander, and cigarette smoke are the most common triggers of asthma. Cows milk is one of the food items that can also trigger asthma.

For those mothers who nurse their babies, please don’t assume that cows milk allergy cannot affect them. If you consume enough dairy products, in the form of milk or cheese, cows milk protein will pass through your breast milk to your child. If he/she has a rather severe allergic tendency to cows milk, even the small amount of cows milk protein can cause some of the above symptoms. One way to find out is to stop taking dairy products yourself for several weeks, and see whether the symptoms disappear in your child. You will need other sources of calcium to save your bones.

It is important to know that cows milk allergy is different from lactose intolerance. Cows milk allergy is due to an allergy to the protein in cow’s milk. Lactose intolerance, on the contrary, is due to the intestines not able to digest and absorb lactose, which is the kind of sugar present in cow’s and human milk. Lactose intolerance can also cause vomiting and diarrhoea. Sometimes it is very difficult to tell the difference. However, lactose intolerance is uncommon in very small babies. It tends to happen after a bout of viral intestinal infection, and in older children or adults. The intestines just lose the ability to produce the enzyme that is required to digest lactose.

How can one decide whether a child’s illness, whether it is in the skin or intestinal tract, is caused by an allergy to cows milk? Blood tests or skin tests are not very helpful at this age. Actually, the best way is to remove cows milk for a period of two to four weeks. If a child has cows milk allergy, most of the symptoms will improve, or completely disappear.

If eliminating cows milk is successful, some specialists even recommend a challenge test after a period of one or two months. If the child receives cows milk again, and develops the same symptoms within a short time, this will be considered a positive test. However, many parents and physicians are not willing to go through this trouble.

If removing cows milk does improve a child’s condition, then how long should one continue? This often depends on the severity of the problem. If the child got very sick and had bloody diarrhoea, it may never be safe to give cows milk or other dairy products again. If the problem is relatively mild, like in your son’s situation, it is reasonable to try homogenized milk after one year of age. Many children with mild symptoms are able to handle regular milk by that time.

I hope that I have given you some insight into your child’s problem. One last piece of advice: children with cows milk allergy can develop allergy to other things. Therefore, you should always keep a watchful eye for any other allergy symptoms.