Confirmation by researching the validity of this alternative

The prevalence of an allergy to the proteins of cow's milk is most significant in childhood and concerns approximately 3% of children under the age of 3: it is indeed the most frequent food allergy among infants.

In most cases this allergy doesn't last a lifetime, since with the passing years a child can acquire tolerance vis-à-vis milk's alimentary elements.  However, 15 % of subjects presenting this allergy also suffer from it as they get older and in adulthood. From a clinical point of view, the allergy to cow's milk proteins can lead to symptoms of varying severity that can concern:

  • the skin (atopic eczema, nettle rash, angio-edema, exanthem);
  • the gastro-intestinal system (growth delay, serious gastroesophageal reflux, chronic diarrhoea, persistent constipation, malabsorption syndrome, recurring vomiting, enterocolitis, inflammation of the rectum);
  • anaphylactic reactions potentially dangerous to life (oedema of the glottis, hypotension that can go as far as shock, acute asthma, skin and acute gastro-intestinal symptoms).

Treatment foundations

The basis of treating an allergy to cow's milk is totally removing from the child's diet this milk (formula milk or genuine cow's milk), its by-products, food that we know contains the above-mentioned proteins (for example biscuits, cakes) as well as "hidden" sources of milk proteins (for example cooked ham with the addition of casein as a preserver, certain types of bread, margarine, ready-made soups, certain medication, etc.). Year on year we re-evaluate the possible acquisition of tolerance by means of ingestion repetition and specific tests to measure the allergy.

In the first two years of life (and particularly during the first year) cow's milk, pasteurised or in another adapted formula and its by-products represent the food with which the child satisfies at least half of his or her energy and nutritional needs; in addition they represent the main source of food calcium, the need for which is very high at these ages.  It is therefore obvious that it isn't possible to prescribe a diet that eliminates cow's milk and its by-products without being able to turn to substitute food, in the first place in milk.  This milk should ideally possess the following characteristics:

  • nutritional adequacy;
  • palatability (a pleasant taste is a condition sine qua non, given the age of young patients;
  • modest price;
  • a hypoallergenicity or a allergenicity (in other words proteins contained in the substitute milk should not be recognised as "enemies" by the immune system, which in this case would cause no type of allergic reaction after ingestion);
  • no cross reactivity with cow's milk (the proteins contained in the substitute milk must therefore not be similar to that of cow's milk from a structural point of view, otherwise the immune system would also react against them, not differentiating between one or the other).

The main American and European paediatrics organisations, that study allergies and gastroenterology today provide for the use of advanced protein hydrolysates or acid formulas or (in some cases) soya protein-based formulas for children allergic to cow's milk who are not breastfeed.

"Advanced hydrolysates" are formulated milks whose proteins (from cow's milk, soya or rice) have been finely "divided up" to be the least recognisable by the immune system as possible; amino acid-based formulas don't even contain small "bits" of proteins but merely simple "beads" (amino acids) of the "necklace" (the proteins).

The milk is therefore totally anallergic because the immune system can no longer recognise the protein that the amino acids come from.  From a nutritional point of view, both these formulas are safe; their cost is unfortunately high and above all their taste is extremely unpleasant, to such an extent that some children (generally the older ones but sometimes also infants aged 6 months and above) refuse to consume it whether sweetened or mixed with fruit.

Soya milks are more economical and clearly more pleasant and totally adapted from a nutritional point of view, but some children allergic to cow's milk are also allergic to that of soya and cannot ingest it, since contraindicated for their type of allergy (for example:  serious weight retardation with malabsorption).  There is therefore a group of children allergic to cow's milk for whom finding a substitute formula isn't easy, either because it isn't possible to use soya milk or because extensive hydrolysed formulas or amino acids are categorically refused by these children.

Milk from other mammals

Some originators have studied the possibility of using milk from other mammals for children with an allergy to cow's milk, like the:

  • buffalo cow;
  • goat;
  • ewe;
  • mare;
  • she-camel;
  • and she-ass.

However the first three cannot be used since the proteins they contain are very similar to that of cow's milk; goat's and ewe's milk are furthermore highly unbalanced for a child from a nutritional point of view.

The first data on mare's and she-camel's milk are interesting, but objective supply difficulties remain in Europe.

Donkey's milk

As for Donkey's milk, it has been studied in two small groups of children allergic to cow's milk, with promising initial results as to its tolerance, digestibility and acceptance by young patients. This milk is indeed pleasant tasting because sweet and it resembles mother's milk.  Furthermore it has nutritional qualities that make it a valid alternative to cow's milk for children allergic to the latter.