Babies with cow’s milk and soy allergies need special formulas that do not contain the proteins they are allergic to. Finding the right formula is crucial for providing babies the nutrients they need for growth and development. This article will explain what cow’s milk and soy allergies are, symptoms, common allergens, and recommended formulas to try. Quick takeaways include:
- Cow’s milk and soy are two of the most common food allergens in babies and young children.
- Symptoms of milk and soy allergies can include skin reactions like eczema, vomiting, diarrhea, abdominal pain, wheezing, etc.
- Specialized formulas made from proteins like extensively hydrolyzed casein, amino acids, and hydrolyzed rice protein are recommended.
- Talk to your pediatrician before switching formulas to ensure your baby’s nutritional needs are met.
What are milk and soy allergies?
Cow’s milk and soy allergies develop when the immune system mistakenly identifies the proteins in these foods as harmful and triggers an immune response. The body releases IgE antibodies that attach to mast cells and basophils containing histamine. When exposed to milk or soy proteins again, they cross-link with the antibodies and cause the cells to release histamine and other inflammatory chemicals resulting in an allergic reaction.
Cow’s milk and soy are two of the most common childhood food allergies, affecting 2-3% and 0.4% of babies respectively. Symptoms typically develop within the first year of life. Most children outgrow milk and soy allergies by school age.
Common Symptoms
Allergic reactions can range from mild to severe. Common symptoms of cow’s milk and soy allergies include:
- Skin reactions: hives, itching, eczema flare-ups
- Gastrointestinal symptoms: vomiting, diarrhea, abdominal cramping, colic, blood in stool
- Respiratory symptoms: runny nose, wheezing, coughing, trouble breathing
- Cardiovascular symptoms: pale skin, dizziness, passing out
Anaphylaxis is a life-threatening reaction that requires an epinephrine injection and emergency medical care. Symptoms of anaphylaxis include swelling of the lips, face, tongue, throat, wheezing, dizziness, trouble breathing, and loss of consciousness.
Common Allergens
The proteins casein and whey are the main allergens found in cow’s milk. Soy allergies are triggered by soy proteins like glycinin and beta-conglycinin. People allergic to cow’s milk are often also allergic to goat’s and sheep’s milk since they contain similar proteins. Most children with soy allergies tolerate soybean oil since it does not contain soy proteins. However, some children react to traces of soy protein in processed foods containing soybean oil or soy lecithin.
Cross-reactivity is also common where people allergic to cow’s milk or soy may react to other legumes in the same plant family such as peanuts, chickpeas, lentils, peas, etc. Those allergic to soy may also react to peas, peanuts, lupine, and green beans. Talk to your doctor about having your child tested for other legume allergies.
Specialized Formulas for Milk and Soy Allergies
Babies allergic to cow’s milk and soy need replacement formulas that meet their nutritional needs for growth and development while avoiding allergenic proteins. The most commonly recommended formulas include:
Extensively Hydrolyzed Casein Formula
Casein is a protein found in cow’s milk. In extensively hydrolyzed formulas, the casein is broken down into smaller peptides that are less likely to trigger an immune response. Examples include Nutramigen, Alimentum, and Pregestimil.
Extensively Hydrolyzed Whey Formula
Whey is the other major milk protein. Hydrolyzed whey formulas like Gerber HA break down whey peptides. They may be an option for infants who react to residual casein peptides in casein hydrolysates.
Amino Acid-Based Formula
Amino acid formulas like Neocate and Elecare are the most hypoallergenic choice since they contain no intact milk or soy proteins. The proteins are broken down into individual amino acids so there are no allergenic epitopes. This formula may be recommended for babies with severe gut reactions who react to residual peptides in hydrolyzed formulas.
Hydrolyzed Rice Protein Formula
Rice protein formulas like PurAmino use proteins sourced from rice that have been enzymatically hydrolyzed into peptides. Rice does not contain the allergenic proteins found in milk and soy. Hydrolyzed rice formulas are also lactose-free.
| Formula | Key Protein Sources |
|---|---|
| Nutramigen | Casein hydrolysate |
| Alimentum | Casein hydrolysate |
| Pregestimil | Casein hydrolysate |
| Gerber HA | Whey protein hydrolysate |
| Neocate | Amino acids |
| PurAmino | Hydrolyzed rice protein |
Soy Protein Isolate
For babies only allergic to cow’s milk, soy protein isolate formulas like Enfamil Prosobee are an option since the soy proteins have been isolated and extensively refined to remove potential allergens. However, infants allergic to soy require a formula based on other protein sources like hydrolysates, amino acids, or rice protein.
Partially Hydrolyzed Formulas
Lightly hydrolyzed formulas like Good Start and Gentlease are sometimes used for babies with milder symptoms or prophylactically in high-risk infants. However, extensively hydrolyzed and amino acid formulas are strongly recommended for infants with diagnosed milk and soy allergies due to their lower allergenicity. Lightly hydrolyzed formulas still contain intact proteins that may provoke reactions.
Choosing the Right Formula
Work closely with your pediatrician to choose the most appropriate formula for your child’s needs and symptoms. Here are some tips:
- Start with an extensively hydrolyzed formula or amino acid formula since they are the least likely to cause an adverse reaction.
- If symptoms improve on the formula, continue using it under medical supervision.
- If reactions continue, switch to a different hydrolysate or amino acid formula.
- Soy formulas are not recommended for infants allergic to cow’s milk due to the high rate of concurrent soy allergy.
- Once the child tolerates a formula well for 6-12 months, graded food challenges can determine if they have outgrown the allergy.
Specialized formulas are not interchangeable. Work with your pediatrician and follow their recommendations closely when transitioning formulas to ensure nutritional adequacy. Never make changes without medical supervision.
Maintaining Adequate Nutrition
Hydrolyzed and amino acid formulas are nutritionally complete and can fully support growth and development when used as directed. Here are some tips to ensure adequate nutrition:
- Follow preparation instructions carefully using the exact amount of water.
- Avoid over-diluting or under-concentrating the formula.
- Choose lactose-free vitamins if your child cannot tolerate lactose.
- Breastfeed if you can since small amounts of milk protein may be tolerated.
- Re-evaluate formula tolerance regularly as the child ages.
- Transition to milk-free solid foods around 4-6 months of age as developmentally appropriate.
Speak to your pediatrician right away if you have concerns about nutrition, growth, or developmental delays. Infants are at higher risk of malnutrition, failure to thrive, and nutrient deficiencies without breastmilk or appropriate formula. Medical oversight is crucial.
Lifestyle adjustments
In addition to specialized formula, the following lifestyle adjustments can help manage milk and soy allergies:
- Avoid products containing cow’s milk or soy as ingredients. Read labels carefully and know alternative names for milk products. Soy lecithin can trigger reactions in highly-sensitive children.
- Prepare bottles and foods in containers that have not contacted allergens. Trace amounts can cause reactions. Designate towels, utensils, pots/pans as milk- or soy-free.
- Find safe substitutes for milk in recipes. Use breastmilk, formula, coconut milk, almond milk, etc. in baking and cooking. Check labels for hidden soy ingredients like soy lecithin.
- Prevent cross-contact. Wash hands before and after meals. Clean surfaces that contacted milk or soy residues.
- Carry emergency medications. Have epinephrine auto-injectors available for anaphylaxis reactions.
- Notify caregivers and schools so they understand how to avoid milk and soy exposure and recognize allergic reactions.
Implementing both a milk/soy-free diet and appropriate early intervention with specialized formula gives babies the best chance at outgrowing the allergy while ensuring proper growth and nutrition.
Other Milk Allergy Formula Options
Along with hydrolyzed milk protein, amino acid-based, and hydrolyzed rice formulas, other specialized formula options for milk allergies include:
Goat’s Milk Formula
The proteins in goat’s milk are similar to cow’s milk and likely to cause cross-reactivity. However, some infants may tolerate it in small amounts if reactions to cow’s milk are mild. Options include Kabrita Goat Milk Toddler Formula.
Extensively Hydrolyzed Casein/Whey Blends
Some formulas combine both hydrolyzed casein and whey, such as Similac Alimentum and EleCare. This ensures adequate amounts of both proteins.
Partially Hydrolyzed Whey/Casein Formulas
Lightly hydrolyzed blends like Good Start Soothe Pro may be an option for milder milk allergies but are not as extensively broken down. Intact proteins remain.
Lactoferrin Formula
Lactoferrin is an iron-binding milk protein that may be better tolerated. In Similac Sensitive, lactoferrin partially replaces casein and whey.
Hemp Milk Formula
Experimental hemp formulas like Hemp Baby contain hemp seed proteins. Little research is available on their use and efficacy.
Other Mammalian Milk Formulas
Some novel formulas derive proteins from milk of other mammals like horses, camels, or donkeys. However, cross-reactivity still occurs. These are not first-line options and require close medical monitoring.
Again, speak with your pediatrician before trying alternative or novel formulas marketed for milk allergy. Extensively hydrolyzed formulas remain the first-line recommendation for most infants. Trials may be considered under medical supervision if reactions to standard formulas occur.
Transitioning to Alternate Formulas
Changing your baby’s formula requires care to avoid nutrition gaps, adverse reactions, or development of new intolerances. Here are some tips when transitioning formulas:
- Consult your pediatrician first and only change formulas under medical supervision.
- Check if the new formula is nutritionally equivalent to ensure key nutrient needs are met.
- Transition slowly over several days, gradually adjusting proportions of old and new formula.
- Watch closely for signs of intolerance like fussiness, rash, vomiting, etc.
- Temporarily use a low-allergen amino acid formula if reactions emerge.
- Increase feeding frequency for extra calories if growth stalls or weight gain suffers.
- Be patient it may take 2-4 weeks to adapt.
Making abrupt formula changes can upset your baby’s digestion and nutrition. Work with your pediatrician to transition gradually and monitor tolerance. This gives your child’s body time to adjust.
When to Trial Cow’s Milk Again
Once your child tolerates a substitute formula for 6-12 months with no reactions, talk to your doctor about trialling cow’s milk again. This is known as a milk challenge:
- Start with a very small amount like 1 teaspoon mixed into a meal or bottle.
- Increase incrementally every few days if no reaction occurs.
- Stop and return to hypoallergenic formula if any symptoms develop.
- Restart attempts in a few weeks or months if the initial trial fails.
- Goal is to introduce as much regular cow’s milk into diet as tolerated.
Around 80% of infants outgrow cow’s milk allergy by age 5. Milk challenges identify when tolerance develops under medical supervision. Proper testing is crucial since accidental exposure at home could cause anaphylaxis if the allergy persists. Be patient and persistent. Multiple trials may be needed over months or years.
Prognosis for Outgrowing Milk and Soy Allergies
The prognosis for outgrowing milk and soy allergies is generally good with 80-90% achieving tolerance by school age:
- Cow’s milk allergy resolves by age 1 in 35%, age 2 in 55%, age 3 in 65%, and age 5 in 80% of children.
- Soy allergy resolves by age 7 in nearly 70% and by age 10 in over 80% of children.
- Children who react to baked milk or have high milk IgE levels take longer to outgrow it.
- A specialist can advise you on your child’s likelihood of outgrowing the allergy based on specific symptoms and diagnostic tests.
The optimal duration to retest tolerance is every 6-12 months while using the hypoallergenic formula. With strict avoidance and appropriate formula, most children eventually outgrow cow’s milk and soy sensitivity.
Conclusion
Finding an appropriate formula is essential for infants with cow’s milk and soy allergy to support healthy growth and nutrition within the first year of life. By using extensively hydrolyzed formulas based on casein, whey, amino acids or rice proteins, most babies get the complete nutrition they need while avoiding allergenic proteins. With proper medical supervision, strict avoidance, and timed oral food challenges, the prognosis is good for tolerating regular cow’s milk and soy formulas by school age in most children. Maintaining close follow-up care with your pediatrician and pediatric allergy specialist offers the best chance of outgrowing these common childhood food allergies.
