Baby
Food Allergies in Babies
By Graciela Wetzler, M.D.
Food allergies in infants and babies are not very common, but they
cause severe discomfort and may even be life-threatening.
During the
first year of life, babies may be allergic to cow's milk or soy protein
present in infant formulas, and breast-fed babies may be allergic to
the same protein in the mother's diet. Symptoms of milk allergies --
vomiting, diarrhea, abdominal pain, bloody stools -- may develop within
minutes or hours of food ingestion. But most gastrointestinal symptoms
develop over the course of days and weeks. Of greatest concern are
those babies with asthma who may have difficulty breathing due to
swelling of the upper airway and may have an anaphylactic reaction.
Milder reactions include eczema, hives, and skin rashes. Irritability
and excessive crying, which mimic infantile colic are additional
symptoms. If milk allergies persist, they may inhibit the baby's
growth.
Milk allergies are due to an immunological reaction against proteins
called casein or whey. When allergic babies are exposed to these
proteins, which may be considered foreign intruders, they become
sensitized, and with each subsequent exposure the symptoms are likely
to worsen. Sensitization may even occur during the last trimester of
pregnancy via the ingestion of dairy products in the mother's diet,
causing symptoms to develop immediately after birth.
For babies with milk allergies, a complete dietary change is
necessary to avoid all products containing casein or whey.
Hypoallergenic formulas are a good substitute since the milk proteins
are already broken into pieces which the baby can tolerate. These
formulas contain all the vitamins and iron that babies require during
the first year of life. Unfortunately, these formulas do not taste good
(although most infants will like them if introduced early in life) and
are quite expensive. It is normal for babies who drink these formulas
to have loose and foul-smelling stools, so parents should not be
concerned.
For breast-fed allergic babies, I usually recommend that mothers cut
out dairy from their own diet. This includes ice cream, cheese, yogurt,
milk, etc. To compensate, mothers should take calcium supplements,
approximately 1,500 mg per day. This regimen will allow the mother to
continue to breastfeed in almost all cases.
Soy is another protein, which can cause allergic reactions, and in
fact many babies who are allergic to milk have a cross-reaction to soy
as well. For this reason, I rarely recommend the use of soy when babies
have milk allergies. However, when hypoallergenic formulas are not
available or affordable, a trial of soy formula may be recommended.
Finally, parents should know that goat's milk has the same composition
as cow's milk and is therefore not hypoallergenic.
Many parents confuse milk allergies with lactose intolerance.
Although it causes some of the same symptoms (abdominal pain, bloating,
diarrhea) lactose intolerance is due to the lack of an enzyme necessary
to digest the sugar in breast milk and formula. It may be a problem
from birth, or more typically it may develop later in life. Since it is
not immunologically caused, lactose intolerance is not considered an
allergic reaction. Soy formulas and milk formulas without the lactose
will cause the symptoms to disappear.
Many babies with milk allergies are referred to pediatric
gastroenterologists when the symptoms are most severe. Diagnostic
testing is often conducted to identify allergens and to evaluate anemia
associated with bloody stool. Endoscopy of the large bowel will
determine the source of bleeding and biopsies may be taken. Although
avoidance of specific foods is the mainstay treatment, sometimes
medications such as antihistamines and steroids are used for acute
allergic reactions.
The good news about cow's milk and soy protein allergies is that
babies outgrow these disorders by 18 months to two years of age. Milk
and soy can then be reintroduced in small amounts and at regular
intervals. As children get older they may become vulnerable to other
food allergies, the most common being to egg, fish, peanut, and wheat.
Many parents mistakenly believe that children are allergic to many
foods, but the most symptoms of food allergies will improve by the
elimination of only one or two foods. Unlike milk and soy, the bad news
about these other food allergies is that they are usually life-long
problems. For children (as well as adults) with severe food allergies,
they should always have access to an Epipen (self-injectable
Epinephrine) to treat unexpected life-threatening reactions.
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About The Author
Dr. Graciela Wetzler is a pediatric gastroenterologist at Maimonides Medical Center in Brooklyn, N.Y.
