Best Formula for Milk Protein Allergy

Figuring out which formula to choose can be extremely stressful (ignoring the shortage at hand), but choosing a formula for a baby with a milk protein allergy is even more complicated. Balancing out which formula will be best for your baby while also keeping in mind the rising costs of formula as they get more specialized is challenging, to say the least.

If your child has recently been diagnosed with a food allergy, I always recommend working with a pediatric registered dietitian. They can help to make sure that your child is meeting all of their nutrient needs. This is not intended as medical advice.

What is Cow’s Milk Protein Allergy (CMPA)?

Like other food allergies, cow’s milk protein allergy is when the body sees the protein in milk as a threat and mounts an immune response to it. Unfortunately, this immune response is over the top and can have serious complications. It is the most common food allergy in babies (1).

It is broken down into 2 main types: IgE mediated and non-IgE mediated. IgE mediated allergies are the food allergies and reactions that we typically think of when we think of food allergies. These reactions tend to happen within 2 hours of having milk and can lead to hives, rashes, wheezing, etc. They may also have symptoms such as vomiting, diarrhea, blood in the stools, and abdominal pain.

Non-IgE mediated allergies can look a little different. These reactions can happen days after ingesting milk, making them much harder to track. These symptoms can be similar to the IgE mediated reactions such as vomiting, abdominal pain, blood or mucus in the stool, and diarrhea. They may also have prolonged fussing, hives, and eczema.

It is important to note that things other than allergies can cause some of these symptoms, so a diagnosis should always be made by a professional.

Differences from Lactose Intolerance

Lactose intolerance is when the body lacks an enzyme called lactase to break down a sugar, lactose, in milk. This can lead to uncomfortable gastrointestinal symptoms. While the symptoms are uncomfortable, they are not life threatening.

Lactose intolerance is very uncommon in infants and young children. Breastmilk’s primary carbohydrate is lactose, so the body generally makes lactase to help break it down. It tends to be more common later in life.

Treatment for CMPA

The treatment for CMPA is removing milk and milk products from the diet. For a breastfeeding parent, this is done by removing milk and milk products from the parent’s diet. Due to a cross-reactivity between milk and soy, some parents are also advised to remove soy from the diet as well. It is usually recommended to work with a dietitian, as it can be difficult to ensure all milk and soy products are removed. In case of accidental exposure to milk or soy, it is recommended to pump that milk and offer other milk or formula until the milk has left the parent’s system. While data is conflicting, one study showed that proteins leave breastmilk after 2-8 hours (2).

For formula feeding families, the treatment is similar. Due to the fact that most formulas are made from either milk or soy, we don’t remove them from the diet, we instead use proteins that are broken down. Because the protein structure no longer resembles that of milk, the body doesn’t recognize it as a threat and doesn’t respond to it.

We do not recommend using soy formula as a replacement, because many babies will have cross-reactivity, meaning they will also react to soy. Goat milk formulas are very similar to cow’s milk and will usually cause a reaction as well.

Hydrolyzed Formulas for Milk Protein Allergy

These are the first types of formulas offered for babies with a milk protein allergy. In these formulas, the proteins are partially broken down so that the body doesn’t recognize them as milk. These formulas are not considered hypoallergenic. They work for about 90% of babies with milk protein allergy. They are easier to find and less costly than the amino acid formulas listed below.

Examples include:

• Similac Alimentum
• Enfamil Nutramigen
• Store Brand “Hypoallergenic” – similar to Nutramigen
• Gerber Good Start Extensive HA
• Althera

Amino Acid Based Formula for Milk Protein Allergy

For the kids who can’t tolerate the hydrolyzed formulas, they can try the amino acid based formulas. In these formulas, the proteins are broken down even further to their building blocks, amino acids. These formulas can also be used by babies with multiple allergies. They tend to be the most expensive and hardest to find, so are used as a last option. Often, you will need to get them from your doctor.

Examples include:

• Alfamino Infant
• Neocate Infant
• Elecare Infant
• PurAmino

So which formula is “best” for milk protein allergy?

Whichever one your baby tolerates. All of these options are nutritionally complete. We generally recommend to start with the hydrolyzed options as they are more accessible. If your baby tolerates that, then I would recommend to continue using it. If not, you can try another formula in that category or work with your doctor or a pediatric dietitian to choose an amino acid based formula.