If symptoms continue after a cow’s milk allergy diagnosis and recommended dietary changes, it could be a sign of severe cow’s milk allergy or multiple food allergies. 

If a baby is diagnosed with severe cow’s milk allergy or multiple food allergies it may be a little daunting. It could be challenging at times and may require patience, organisation and careful planning, but parents wouldn’t be alone. Support from healthcare professionals would help ensure babies got all the nutrients they needed. Here we outline some considerations for managing severe cow’s milk allergy or multiple food allergies.  

Dietary changes for formula-fed babies

If a formula-fed baby is diagnosed with severe cow’s milk allergy or multiple food allergies, has had a severe reaction such as anaphylaxis or still has symptoms when prescribed an extensively hydrolysed formula, healthcare professionals may recommend an amino acid-based hypoallergenic formula. Find out more about the dietary changes that healthcare professionals may recommend for babies diagnosed with severe cow’s milk allergy or multiple food allergies.

Support from a dietitian

A dietitian with allergy experience can help with advice on foods to avoid and how to help make sure babies get all the nutrients they need from the foods they can have. If a baby is diagnosed with severe cow’s milk allergy or multiple food allergies, doctors can make a referral to a dietitian to provide this support.

Considerations when cooking 

The more allergies a baby has, or the more severely they react to allergens, the more complicated providing meals for them may be. Parents will need to:

Always look very carefully at every food label

Food labels must be read to look for the presence of allergens that need to be avoided, even if you think you know the product from previous use. Companies often change recipes or move production to different factories so ingredients and warning information can change. In the EU, food labels emphasise the allergens that are present within the ingredients list. 

Be mindful of the risk of cross-contamination

Cross-contamination at home can occur when food is prepared or served on surfaces that have been exposed to other foods containing an allergen. It is therefore particularly important to always use different utensils and pans when preparing food for a baby with severe cow’s milk allergy or multiple food allergies.

Plan meals and snacks in advance

Planning ahead is key to ensure a baby with severe or multiple food allergies is not exposed to allergens. Parents may need to become confident in adapting recipes, and make meals and snacks in advance when eating away from home. Cooking in bulk and freezing with clear labels is a good idea. 

Anaphylaxis 

Anaphylaxis, or anaphylactic shock, is a severe symptom of an allergy and can be life threatening. With any allergy this is a concern, but it is a particular worry when a baby has severe cow’s milk allergy or multiple food allergies as the chances of it occurring may be increased. In cow's milk allergy, anaphylaxis is a severe symptom associated with IgE-mediated allergy. Not every baby with allergies will experience an anaphylactic shock but it is important that parents understand what it is and how to manage it so that they can recognise and respond quickly and calmly if it does occur.

Anaphylaxis usually occurs suddenly after exposure to the allergen and quickly gets worse. Symptoms include: 

• Swelling of the tongue or throat
• Difficulty in swallowing or speaking
• Wheezing, persistent cough or severe asthma
• Dizziness, collapse of loss of consciousness (floppiness in babies)
• Fast heartbeat
• Clammy skin
• Itchy, raised rash
• Feeling or being sick
• Stomach pain

If you suspect anaphylaxis you should call for an ambulance immediately.

If a healthcare professional thinks a baby is at risk of anaphylaxis they may prescribe an adrenaline auto-injector pen. Parents will be trained on how to use them so that they can administer the adrenaline in the event of an anaphylactic shock.