Infant formula for cows' milk allergy

Non-dairy infant formula

Non-dairy infant formulas are used for infants with cows' milk allergy (CMA) who are unable to be breastfed. CMA occurs when your baby’s immune system reacts to the protein in cows' milk.

Key points

  1. If your child is diagnosed with a cows' milk allergy (CMA), you may need to completely cut out cows' milk and dairy products from their diet. Read more about cows' milk allergy.
  2. Non-dairy infant formulas are used for infants with CMA. 
  3. There are 3 main types of non-dairy infant formula – soy formula, extensively hydrolysed formula (eHF) and amino acid formula (AAF).
  4. The type of infant formula that is best for your baby will depend on their age and the type of allergy they have to cows' milk.

What is cows' milk allergy (CMA)?

Cows' milk allergy (CMA) occurs when your baby’s immune system reacts to the protein in cows' milk. Babies that have CMA usually have symptoms during the first few months of life. They generally grow out of it before the age of 3 years.

CMA is a common childhood allergy, affecting 2–3% of children (ie, up to 3 in every 100 children) before the age of 3 years. Babies who have close family members (parent, brother or sister) with allergic conditions such as eczema and asthma are more likely to have CMA.

There are 2 main types of CMA:

  • IgE-mediated CMA – symptoms appear within minutes or up to 2 hours after having cows' milk protein.
  • Non-IgE-mediated CMA – symptoms usually appear after 2 hours up to a few days after having cows' milk protein.

Some babies may have symptoms of both IgE-mediated and non-IgE-mediated allergy (referred to as mixed allergic reaction). ​

Read more about cows' milk allergy.

Which infant formula is suitable for CMA?

There are 3 main types of non-dairy infant formula:

  • soy formula
  • extensively hydrolysed formula (eHF)
  • amino acid formula (AAF).

The type of infant formula that is best for your baby depends on their age and the type of allergy to cows' milk they have. Your doctor or dietitian will advise you on which infant formula to try.

Soy formula

Soy formula is made from soybeans, not cows' milk. It is an option for treatment of CMA in infants aged over 6 months. Soy formula is not hypoallergenic and is generally not advised for infants under 6 months.

Extensively hydrolysed formula (eHF)

Cows' milk contains 2 types of protein: casein and whey. Babies with CMA may be allergic to one or both of these proteins. Hydrolysed formula contains cows' milk proteins that have been broken down into small particles called peptides, which are less likely to cause an allergic reaction. 

In general, the more extensive the hydrolysis of the protein, the less likely it is to cause an allergic response. Extensively hydrolysed formula is suitable for most infants who have non IgE- mediated allergy CMA. Examples of extensively hydrolysed formula are Allerpro 1, Allerpro 2 and Aptamil Gold+Pepti Junior.  

Amino acid formula (AAF)

Amino acid formula does not contain any cows' milk protein. These formulas are least likely to cause an allergic reaction. They are used where there has been anaphylaxis to cow milk, or where eHF is not tolerated or does not resolve symptoms. 

About 10% of infants do not tolerate extensively hydrolysed formula and need amino acid formula. Examples of amino acid formula include Alfamino Junior, Elecare and Neocate.

Funding of infant formula for CMA in New Zealand

In New Zealand, infant formula for CMA is fully funded on prescription. It requires a special authority applied for by your doctor, dietitian or specialist based on specified criteria.

  • Extensively hydrolysed formula, Allerpro 1, Allerpro 2 and Aptamil Gold+Pepti Junior is funded according to the specified criteria SA1557
  • Amino acid formula Alfamino Junior, Elecare and Neocate is funded according to the specified criteria SA1219. 

Note: From 1 July 2020 the existing special authority will be replaced with a new form that includes 2 different sets of funding criteria for infants up to 12 months of age and children 12 months of age and over. See amino acid infant formula (PHARMAC)

What infant formulas are not suitable for CMA?

There are many other infant formulas available that are not suitable for CMA:

  • Partially hydrolysed formula – the cows' milk protein has been only partially broken down so can still cause an allergy. Examples include Karicare HA and Nan HA Gold Protect.
  • Goat’s milk, sheep milk, mare’s milk – these animal milks are not suitable for children or adults with CMA as the proteins are very similar to those in cows' milk and most infants will react to these too.
  • Rice milk, oat milk, almond milk, cashew nut milk, coconut milk – these plant-based milks are lower in energy, protein and fat. Some are fortified with calcium and B vitamins. Rice milk is not recommended for children under 5 years of age as the sole milk replacement because it does not meet their nutritional needs but can be used as a supplement with dietitian assistance. 

Learn more

Cows' milk allergy – what do you need to know Health Navigator NZ
How long does cow's milk allergy last? Allergy NZ
Lactulose intolerance Health Navigator NZ
Feeding your baby infant formula Health Navigator NZ

References

  1. Managing cows’ milk protein allergy in infants BPAC, NZ, 2019
  2. Cow's milk allergy Allergy New Zealand
  3. Replacements for cow’s milk Allergy New Zealand
Credits: Health Navigator Editorial Team. Reviewed By: Dr Jan Sinclair, Paediatric Allergy and Clinical Immunology, Starship, Auckland Last reviewed: 11 Mar 2020