Cows Milk Allergy Can Cause Eczema

Question: We have recently moved to California. Our daughter is eight months old. I have nursed her since birth. At around two months of age, she developed eczema all over her body. Our paediatrician suggested that I should stop drinking milk and stop eating dairy products. Within a few weeks, her eczema almost completely cleared. Later, when I tried to give her a bottle of regular formula, she became very irritable and vomited, and her eczema reappeared for a while. Our paediatrician suggested that she is likely allergic to cows’ milk. Now, whenever I need to give her a bottle, which is very seldom indeed, I give her soy formula instead. I am planning to nurse her as long as I can, but I wonder whether she will ever be able to drink regular milk or eat ice cream. My husband has a lot of allergies, is it possible that this may have something to do with our daughter’s eczema? If it is related, is there anything that we can do to prevent her from developing more allergies?

Answer:

You have an interesting medical condition and you have asked some very important questions. Before answering your questions on food allergy, let me discuss about feeding young children in general for the benefit of other parents.

Feeding a growing infant is hardly the easiest thing for any parent. There is always the concern whether you have fed her enough. Whenever she cries, you would wonder whether she is hungry or not. However, in the present North American situation, we actually have to be more concerned about overfeeding our children. Obesity often begins early in life, and it is a very difficult problem to overcome.

In addition to how much to feed your child, there are questions about when to introduce what food at what time. There is an endless list of questions regarding feeding young children. This is the reason why there are so many parenting magazines and books out there, with all kinds of suggestions from all sorts of specialists. However, when one reads these suggestions, they are sometimes confusing and often contradictory, making it difficult for parents to decide what is the best for their children.

Let me begin by congratulating you for giving your daughter the best birthday present on the day when she was born. Choosing to breast-feed your daughter means that you are providing her with the best possible nutrition for the first part of her life. There is no commercial formula that can match breast milk. You may hear from time to time that certain formula company has produced an improved infant formula. If the formula is that great, why would they have to improve it to begin with? On the contrary, breast milk has sustained the human race for millions of years. It is the product of successful evolution, and does not require any further improvement.

In addition to providing proper nutrition for your daughter’s growth and development, breast milk contains natural antibodies that help to protect her from germs that she would encounters. This does not imply that she will not get sick. However, breast-feeding does reduce the frequency and severity of many childhood infections, especially diarrhea.

Breast feeding also promotes the special kind of bonding and closeness between the mother and her infant. Nobody can replace the mother who is breast-feeding, and the breast milk is always ready whenever the baby is hungry. There is no need to prepare or warm up the formula. I am not implying that there is less bonding between the mother and the bottle-fed infant, however, I do believe that breast-feeding does foster more closeness between the two.

You may also have heard that recent research indicates that children who were breast-fed in the first few months of life have slightly higher intelligence than those who received infant formula. Some researchers suspect that this may be related to Arachidonic Acid (AA) and Docosahexaenoic Acid (DHA), two very long chain poly-unsaturated fatty acids that are found in breast milk, but not in regular formulas. Both AA and DHA are important in the development of brain tissues and retina, the light sensitive layer in our eyes.

It is still unclear whether AA and DHA should be present in infant formulas. Both of them can be produced by infants from other fatty acids which are already present in regular formulas. However, some formula companies are beginning to add AA and DHA in their products and market them as another improvement. The real significance of this addition still requires further research. This is yet another proof that breast milk is superior to any artificial formula.

Choosing to breast feed may not be an easy choice, depending on where a woman lives. In western Canada, about 80% of women start breast-feeding in the hospital after their babies are born. If we move east, the breast feeding rate steadily declines to the lowest in Atlantic Canada, which is around 50-60%. There are many reasons why women choose to feed their babies with formula. This discussion is lengthy and is beyond the scope of this column.

You may wonder how long you should continue to nurse your daughter. The decision is often affected by the mother’s career: how long is her maternity leave. In Canada, although we have legislature providing women with twelve months of maternity leave, many women who have seasonal or contract jobs, unfortunately, have to return to work prematurely due to financial pressure.

If you are not under such influence, the Canadian Paediatric Society and the American Academy of Pediatrics (the two associations that represent most paediatricians in North America) recommend breast-feeding for two years for all infants. Some women continue to nurse their child beyond that age, until the baby decides to wean, and this is perfectly safe and healthy.

If you have to return to work before your daughter is ready to wean, you can still continue to nurse her. Many women would nurse their infants before work, and after returning home. During the work hours, they would express breast milk (either by hand or by using a pump) and store it. The child’s caretaker can feed the baby with the mother’s milk using a cup or a bottle.

When to introduce solid food is also a question that I get asked frequently by many parents. In general, most children are ready between 4-6 months of age, when they have learned to use their tongue to move food to the back of their mouth and then swallow. Of course, one has to start with food that is very soft. The most common food that is used in North America is baby cereal. It can be mixed with breast milk, or if the child is on commercial formula, then this can be used to mix with the cereal.

The most common food in an infant’s diet that can induce allergy is cows’ milk. This is frequently not recognized by many parents. Cows’ milk allergy can show up in many ways. Some children can develop irritability after feeding, others would have vomiting or diarrhea. When it is severe, a child may not be able to absorb any food, and can develop malnutrition.

Eczema, an allergic condition of the skin, is a common symptom of milk allergy. This can happen even to breast-feeding babies. When the mother drinks cows’ milk or eats dairy products, part of the cows’ milk protein passes through the mother’s breast milk to the infant. If the child has a genetic tendency to develop allergy, like in your daughter’s situation, she can develop allergic symptoms like eczema, even though she was never given any cows’ milk directly.

The best way to find out whether eczema is caused by cows’ milk is for the mother to stop all dairy products for several weeks. It is important to do this for long enough time to see whether it makes any difference. If it does, then the mother has to avoid dairy products throughout breast feeding. These women have to be careful to ensure that they eat a nutritious diet, with enough fat and protein. They also need to get additional calcium supplement to avoid losing excessive amount of calcium from their bones.

Fortunately, cows’ milk allergy is not necessarily a life-long problem. Many children who have documented allergy can tolerate some milk and other dairy products later. If your daughter decides to stop nursing in the near future, you should give her a soy formula until she is at least one year of age. At that time, you can give her a small amount of homogenized milk, and see what happens. If she develops any allergic symptom, you should stop it right away and continue her on the soy formula, or give her commercial soy drinks that are available in most supermarkets. Many of them are fortified with Vitamin D and calcium, just like homogenized milk.

Some children can drink a small amount of cows’ milk or eat some cheese and ice cream when they are three or four years of age. However, many children with cows’ milk allergy continue to stay away from dairy products voluntarily, probably because they have milder intestinal symptoms that are unrecognized even by their parents. You may be interested to know that there are ice cream and cheese made from soy.

A small proportion of children who has milk allergy can develop allergy to soy also. This is a very unfortunate situation because by the time parents find out this problem, it is already too late to consider breast-feeding. Some parents would use goats’ milk, but it is not readily available in many communities. Another option is to use specialized formulas that are designed for infants with serious allergies. However, these formulas are very expensive. Many of these parents wished that they had started breast-feeding when their children were born.

Allergic conditions like eczema is passed from one generation to another through the parents’ genes. If your husband has a lot of allergies, it is quite possible that he has passed these genes to your daughter. However, it is also possible that your side of the family may also carry these genes without even knowing it. Anyway, there is no reason to place blame here, but it is important to recognize that allergy does run in the family, and eczema is an allergic condition.

I am very pleased to hear that you are looking ahead and want to prevent your daughter from future allergies. Unfortunately, there is nothing that can absolutely prevent this from happening, although there are a few things that you can do to reduce this possibility.

[[Recent research has shown that children with eczema have a higher chance of developing other food allergies, especially to peanuts and other nuts.  It turns out that early introduction of these foods can prevent serious and sometimes life-threatening allergy.  The best time to introduce peanut to a baby with eczema is between 4-6 months of age.  Some specialists even suggest doing allergy tests before introducing peanut to the baby.  This is still an evolving concept that may see further change in recommendation in the next few years.]]

You should also watch for symptoms of other allergic conditions like seasonal hayfever and asthma. Research has clearly shown that children with eczema has a high chance of developing asthma.

I hope you have gained some insight regarding food allergies. I encourage you to discuss with your family doctor or paediatrician regularly regarding when and how to introduce different foods to your daughter.

[Note to Readers: Because of significant change in recommendation in recent years regarding introduction of solid foods and food allergy, a new paragraph was added above [[     ]], replacing an outdated paragraph.  Please read other columns also regarding food allergy.]