Recently a mother brought her 17-month-old child to see me with a history of cow’s milk protein allergy (CMP). She asked me whether she could use goat’s milk instead and if there’d be any risk to doing so. My only recollection about goat’s milk from my pediatric training was that it was inadequate for children because it was low in folic acid and so shouldn’t be recommended. The question, however, piqued my curiosity and I wondered whether it would be a good alternative for kids with CMP allergy, which has a prevalence of about 2.5% during the first three years of life.¹

Parents who turn to the internet will come upon the site, Dynamic Chiropractic, (www.dynamicchiropractic.com) and read the topic, “Goat’s milk: a natural alternative for milk sensitive patients.” It concludes, “Goat milk is an excellent option for any patient who is cow milk or soy milk sensitive…”

Comparable milk proteins

A quick literature search didn’t turn up many studies looking at this question. One trial, though, showed that there’s significant cross-reactivity between kids who have CMP allergy and allergy to goat’s milk. In this study, 26 children with proven CMP allergy were tested for goat’s milk allergy using prick tests, specific IgE, and double-blind, placebo-controlled oral challenges. All the subjects had positive prick tests and 24/26 had a positive, double-blind oral challenge to goat’s milk.² There are similarities between the beta-lactoglobulins and the alpha-caseins in cow’s milk and goat’s milk that may account for this cross-reactivity. Alpha-caseins from cows, goats and sheep share 87-98% of their amino acids.³

A recent case report highlights the dangers of giving goat’s milk to CMP allergic children. A 4-month-old infant who was intolerant of a cow’s milk formula was sent home from the nursery on a soy formula. Subsequently, on the advice of a relative, the mother gave the infant goat’s milk. The baby had an anaphylactic reaction requiring treatment with oxygen, adrenaline and steroids. A subsequent prick test revealed a significant reaction to goat’s milk.⁴

When allergy-free

Despite the dearth of literature on goat’s milk, there appears to be a strong correlation between CMP allergy and goat’s milk allergy; therefore, one should not recommend goat’s milk in this group of patients. This leaves open the question of whether goat’s milk is a suitable alternative to cow’s milk in non-allergic patients. It would appear that this is a safe alternative in patients who have no allergies as long as the goat’s milk is enriched with folic acid and vitamin D. Check out the table at www.goatconnection.com/articles/publish/article_152.shtml It compares the composition of goat’s milk with cow’s milk and human milk.

I have recently seen another infant whose mother uses goat’s milk (and a folic acid supplement). Her baby does not have a cow’s milk allergy and she gives it because of personal preference. This infant is thriving and her biochemistries including hemoglobin and folic acid were normal. I wonder how many of you have any experience with using goat’s milk in your patients and whether you’ve encountered any adverse effects? I would love to hear from you.

Reference

1. Passalacqua,VD et al. Ass’s milk in children with atopic dermatitis and cow’s milk allergy: crossover comparison with goat’s milk. Pediatric Allergy and Immunology 2007:18:594-8.
2. Bellioni-Buscino, B et al. Allergenicity of goat’s milk in children with cow’s milk allergy. J Allergy and Clin Immunol June 1999, p1191-4.
3. Ibid, p1193.
4. Pessler, F et al. Anaphylactic reaction to goat’s milk in a cow’s milk-allergic infant. Pediatric Allergy and Immunology 2004:15:183-5.