What is the Best Infant Formula for Milk Protein Allergy?
Concern for milk protein allergy (MPA), also called cow milk protein allergy (CMPA), is a fairly common concern among parents who are navigating infant feeding challenges, as milk allergy is one of the most common food allergies we see during infancy. If your baby is diagnosed with MPA, understanding the right formula and/or breastfeeding modifications to use is important for your baby’s health, comfort, and safety.
Choosing the right baby formula for milk allergy in infants involves careful consideration of the symptoms and the type of formula that best suits their needs. Most likely, your healthcare provider or dietitian will recommend a specialized formula to help control symptoms and prevent allergic reactions. Soy formulas may also be considered as an alternative but should be evaluated on a case-by-case basis.
In this blog post, we’ll cover the types of MPA and their cow milk allergy symptoms, how long it takes for an allergy to appear when taking formula, and which are the best formulas for dairy allergy in infants with MPA.
What is Milk Protein Allergy?
Milk protein allergy (MPA), also known as cow’s milk protein allergy (CMPA), is an adverse reaction to the protein molecules found in cow’s milk, which include whey and casein. This immune response can be expressed in various forms, ranging from mild discomfort to severe allergic reactions with symptoms of anaphylaxis in some cases, although severe reactions are uncommon in infancy.
MPA is more common among males, formula-fed babies, and those with atopic conditions such as eczema and asthma.
There are two primary types of milk protein allergy: IgE-mediated and non-IgE-mediated. An IgE-mediated allergy involves the immune system producing antibodies called immunoglobulin E (IgE) in response to milk proteins. Non-IgE-mediated allergy, on the other hand, involves delayed reactions that most often cause signs and symptoms affecting the digestive system, although the skin and other organs can be affected as well.
What are Cow Milk Protein Allergy Symptoms?
Cow milk protein allergy (CMPA) in infants can cause a range of symptoms.
Symptoms of IgE-mediated allergy typically occur within a few minutes and up to 2 hours after ingestion and can include immediate allergic reactions, including anaphylaxis, facial swelling, hives, wheezing, and trouble breathing. IgE-mediated symptoms can be fairly mild to severe.
Non-IgE-mediated allergic reactions usually have a delayed onset and occur after 2 hours or more of ingesting milk proteins. Symptoms typically include gas, diarrhea, and bloody stools. Non-IgE-mediated MPA typically involves the GI tract, but less commonly will also affect the skin and may lead to respiratory symptoms as well.
It’s important to note that these symptoms of milk allergy can vary and may overlap with other conditions. If you suspect your baby has a milk protein allergy, consult with a healthcare professional and/or allergy specialist for an accurate diagnosis, and do not try to diagnose an allergy yourself.
How Long Does It Take for a Formula Allergy to Appear?
The onset of cow milk formula allergy symptoms in infants can vary, but signs typically start appearing within hours to a few days after introducing a new formula. Most symptoms of MPA appear within the first few weeks of life.
If you switch to a new formula and notice signs of an allergic reaction, it’s important to call your pediatrician or healthcare provider right away. The timing and severity of the reaction can vary depending on the individual's sensitivity and the formula type.
What is the Best Formula for Milk Protein Allergy?
When choosing a formula for an infant with a MPA, it’s essential to choose one that is specifically designed to address their condition, also called a “hypoallergenic” formula.
Formulas that are extensively hydrolyzed or made from alternative proteins (such as elemental or amino acid formulas) are generally recommended, and you may be able to get a prescription formula for milk protein allergy from your baby’s healthcare provider. These formulas either have fragments of milk proteins that are less likely to trigger an allergic reaction or are made of alternative proteins.
Infants with MPA should not use a formula made with goat's milk or milk from other mammals because of high rates of cross-reactivity with cow's milk proteins and the risk for allergic reactions.
The U.S. Food and Drug Administration (FDA) tightly regulates all commercially marketed infant formulas in the U.S. It is important to avoid making your own homemade formula or purchasing an illegally imported formula from outside the United States, as these come with risks, including possible nutrient and electrolyte imbalances and foodborne illness.
What is a Hydrolyzed Formula?
Hydrolyzed formulas are often recommended when a baby shows symptoms of cow's milk protein allergy or intolerance, such as colic, eczema, or digestive issues like reflux or constipation. A hydrolyzed formula is specially processed to break down milk proteins into smaller pieces, helping make the formula easier to digest and reduce the likelihood of an allergic reaction.
There are two main types of hydrolyzed formulas: partially hydrolyzed and extensively hydrolyzed, which are further discussed below.
These formulas do not require a prescription and can generally be purchased over the counter. However, some insurance and the WIC office (Special Supplemental Nutrition Program for Women, Infants, and Children) will help cover the cost of a hydrolyzed formula if a healthcare provider writes a prescription.
What is the Difference Between a Partially and Extensively Hydrolyzed Formula?
Partially Hydrolyzed Formula: Proteins are partially broken down into smaller pieces. These are generally intended for infants with mild to moderate digestive sensitivities. They are generally not suitable for infants with milk protein allergies because they still contain fragments of cow’s milk proteins.
Extensively Hydrolyzed Formula: Proteins are broken down into even smaller fragments. These formulas are designed for infants with more severe milk protein allergies and are less likely to cause an allergic reaction.
What are amino acid-based formulas?
According to the Centers for Disease Control, amino-acid-based formulas, also called elemental formulas, are often recommended for infants with severe milk protein allergies and other food allergies. Unlike standard cow’s milk-based formulas, which use whole proteins or partially hydrolyzed dairy proteins, amino acid-based formulas are made from individual amino acids, which are the building blocks of proteins.
These formulas are often recommended when other hypoallergenic formulas, such as extensively hydrolyzed formulas, are not effective. Since amino acids are the simplest form of protein and are unlikely to trigger an allergic response, these formulas provide a safe and easily digestible alternative for infants with very sensitive immune systems.
In addition to their hypoallergenic properties, amino acid-based formulas are carefully balanced to meet all of an infant's nutritional needs, including proteins, fats, carbohydrates, vitamins, and minerals. They typically require a prescription and are used under the guidance of a healthcare professional to ensure they are the best option for your baby's specific health requirements.
Best Formula for Milk Allergy and Acid Reflux (GER, GERD)
Gastroesophageal reflux (GER) is a common and normal process in children whatever their age. It is defined as the passage of contents from the stomach into the esophagus, with or without regurgitation or vomiting. GER is just the medical term for spitting up and is a completely normal and expected occurrence in infants less than a year old.
Gastroesophageal reflux disease or GERD is when reflux has become a problem when a baby with excessive spit up has poor weight gain, episodes of extreme distress (with or without spit up), poor appetite or refusal to eat, gagging, coughing or wheezing, or poor sleep habits.
Some of the symptoms of MPA in a baby can also be symptoms of GERD. Therefore, some infants with GERD may have improved symptoms following a cow’s milk protein-free diet.
If breastfeeding, mothers can try a dairy-free diet for 2-4 weeks. If a baby is formula feeding, offering a hypoallergenic formula for 2-4 weeks to evaluate for improvement may help (see list below).
Some babies will need additional support with medications or thickened feedings (using infant oat cereal). It is important to make these decisions with your child’s pediatrician or dietitian to determine the best treatment plan.
Hypoallergenic and Extensively Hydrolyzed Formula List
The formula list below includes both extensively hydrolyzed formulas and elemental formulas. Choosing the best one for your child will require guidance from a pediatrician, allergist, or dietitian, as some infants may only require a hydrolyzed formula while others may need an elemental formula depending on the type and severity of their MPA.
1. Enfamil Nutramigen - A widely used, extensively hydrolyzed formula
2. Similac Alimentum - Another popular extensively hydrolyzed formula
3. Neocate - A hypoallergenic, dairy-free amino acid-based infant formula
4. Similac Elecare - Another hypoallergenic, dairy-free amino acid-based infant formula
Are Soy Formulas Recommended for Milk Protein Allergy?
While soy formulas can be a good alternative for some infants with milk protein intolerance, according to the American Academy of Pediatrics, they are not universally recommended for infants because up to half the infants who have milk allergies are also allergic to soy protein.
Choosing the right infant formula for a baby with a milk protein allergy can be challenging, but understanding your options can make the process more manageable. Whether you opt for an extensively hydrolyzed formula, amino acid-based formula, or soy formula, it's crucial to consult with a healthcare provider to ensure the formula meets your baby's specific needs.
Remember, each baby is unique, and what works for one may not work for another. By staying informed and seeking professional guidance, you can make the best choice for your baby's health and well-being. Ultimately, your baby's comfort, nutrition, and safety are the top priorities, and with the right formula, you can ensure they get the care and nourishment they need to thrive.
If you’re interested in learning more about how and when to integrate foods into your baby's diet, as well as how to reduce the risk of food allergies during infancy, check out my new baby-led feeding cookbook!
And if you're looking for personalized nutrition support for your babies or kids, I am currently accepting new clients in my virtual private practice.
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