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Be Well for Parents - February 2011 Issue

Cow’s Milk Protein Allergy: A Primer

Could this be the reason your baby ‘burps up’ the bottle?

You cradle your baby in your arms and give her a gently warmed bottle of formula. Within minutes, the peaceful scene is shattered by screams, followed by vomiting.

Could your baby be allergic to milk?

“There are many possible causes for this scenario. If it occurs frequently, it may be an allergy to the proteins in cow’s milk,” says Brian Schroer, MD, a pediatric allergist at Cleveland Clinic Children’s Hospital.

“Cow’s milk protein gastrointestinal allergy is not uncommon in infants and children, and can lead to diarrhea, vomiting, bloody stools and poor weight gain.”

This type of allergic reaction is different from the immediate, life-threatening reaction to foods such as tree nuts, eggs and shellfish. These classic food allergies create an immune system reaction that requires immediate treatment with epinephrine or an antihistamine.

Nevertheless, “all allergies require 100 percent avoidance of the food,” says Dr. Schroer.

Treatment is easy, but see a doctor

Cow’s milk protein allergy is typically diagnosed when symptoms resolve following a doctor-recommended change in formula (the most effective treatment).

If you suspect that your child has an allergy to cow’s milk formula, ask your pediatrician for advice before you change formulas on your own. The doctor may recommend switching to an alternative formula that is soy-based or, if your baby is allergic to soy, to an advanced hypoallergenic formula.

Also, “if you are breast-feeding your baby, speak with your doctor. You will likely be able to continue nursing,” says Dr. Schroer.

Lactose intolerance: a different animal

Cow’s milk protein gastrointestinal allergy is commonly confused with lactose intolerance. However, the two are very different.

“Lactose intolerance is rare in infants and children under age 2. It generally starts to develop after age 5 and will tend to worsen as the child grows older,” says Dr. Schroer.

People who are lactose-intolerant lack the enzyme necessary to digest lactose, a sugar found in milk. Drinking milk or eating foods containing lactose can produce an unpleasant digestive response, but the condition is neither deadly nor fatal. It can be treated by avoiding lactose or by taking a dietary supplement that contains the missing enzyme.

If you suspect an older child has developed lactose intolerance, seeking advice from a pediatrician or pediatric gastroenterologist can be helpful.

Growing out of cow’s milk protein allergy

If you learn your child has an allergy to cow’s milk protein, Dr. Schroer offers these encouraging words: “Most kids will outgrow the allergy.”

How will you know when this occurs? By monitoring your child’s reaction to dairy foods that have been introduced with your doctor’s blessing.

“If your baby has an allergy to cow’s milk protein, avoid introducing cheese, yogurt or any other solid food that contains cow’s milk protein during the first year,” Dr. Schroer advises. “Your pediatrician or allergist can help to determine when it might be safe to introduce cow’s milk back into your baby’s diet, usually after the age of 1.”

“If symptoms recur, you may have to wait six months to a year before your physician can retest your child to see if he or she has outgrown the allergy.”

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Virtual hazing: Help kids stand up to cyberbullies

Cyberbullying affects more than half of all adolescents every day. The virtual world protects kids from witnessing the devastation this antisocial behavior causes. Teach your child to respect others, stand up for friends, use privacy settings and come to you when problems arise. Learn more in a free webchat with our experts Friday, Feb. 18, 2011, noon to 1 p.m. EST.

Children's Health Essentials – February 2011 Issue

Heart Disease: Combining Diets to Minimize Risks

By Melissa Ohlson, RD, LD

It’s never too late to make changes in your diet to minimize your risk of cardiovascular disease. Deciphering legitimate from misleading recommendations on the Web is a challenge. The good news is, we’ve done the research for you. Here is our “no-surfing” guide to eating that will effectively lower your cholesterol.

Revisiting the Mediterranean

A landmark, decades-old trial called the Seven Countries Study observed that men from Greece, Italy and other Mediterranean countries enjoyed a longer life expectancy and a lower rate of cardiovascular disease than men from countries such as ours.

Hundreds of studies on eating patterns in the Mediterranean have since followed. Overall, they showed that adopting traditional Mediterranean dietary practices can lower rates of cardiovascular disease, diabetes, cancer and other debilitating diseases.

Many surmise that the monounsaturated, fat-rich olive oil used in the Mediterranean provides the greatest cardiovascular protection. However, eating a diet rich in fruits, vegetables, whole grains, nuts and seeds, legumes, fish, red wine and modest animal protein appears to have even greater impact.

Looking through the Portfolio diet

Other studies have looked at the influence of individual foods and eating patterns on cholesterol and heart disease. One such study involved the Portfolio diet, which incorporates a variety of heart-healthy foods (such as margarine rich in plant sterols, almonds, soy, psyllium fiber, fruits and vegetables) into a vegetarian diet.

The Portfolio diet was found to lower cholesterol an astounding 30 percent — equal to the percentage commonly seen with a starting dose of statins (common cholesterol-lowering drugs). This study clearly showed that diet could indeed lower cholesterol, and that diet can work synergistically with statins to keep heart disease risks low.

Getting the best of both worlds

Researchers in Toronto, Canada, wondered whether combining the monounsaturated fat-rich Mediterranean diet with the plant-based, lower-fat Portfolio diet would have the greatest impact of all on cholesterol.

So they took 24 patients with moderately high cholesterol and split them into two groups: the Portfolio diet group and the Portfolio diet plus higher monounsaturated fats group. In the latter group, 13 percent of “calories from carbohydrates” came from sunflower oil, a good source of monounsaturated fat. After two months, that group — with the extra monounsaturated fats —lowered their LDL (bad) cholesterol 35 percent and raised their good (HDL) cholesterol 12.5 percent.

It appears that the added monounsaturated fats were able to do what the Portfolio-only diet could not do: raise heart-protective HDL cholesterol.

The best deal from these findings: You get to eat foods that are whole or minimally processed, taste great and are easily added to your diet. Apply the lessons learned from this research, and start today — your heart will thank you.

Combined diet: 7 tips for applying study findings to your plate

No need to travel to Crete for good things to eat — just visit your local grocer.

Remember not to simply add these new foods to your diet; they must replace unhealthier foods, or weight gain will become another obstacle to heart health.

  1. Bump up fruits and vegetables. We’re talking nine or more servings a day! Add berries to your morning bowl of oats. Munch on veggies for a snack. Toss dark leafy greens into your family’s favorite marinara sauce. Enjoy fresh fruit for dessert.
  2. Add lots of legumes. Enjoy a warm bowl of hearty lentil soup. Toss garbanzo beans into cooked whole-wheat couscous. Spread hummus onto pita bread. Enjoy a black bean taco salad.
  3. Seek out soluble fiber. Start your day with a warm bowl of old-fashioned oats. Toss ground flaxseed over yogurt or cereal. Serve barley in homemade soup. Add psyllium fiber to foods or buy cereals like All-Bran Bran Buds® with psyllium.
  4. Mix almonds and other nuts into your day. Plan to add at least one-half to 1 ounce of nuts to meals or as stand-alone snacks each day. (One ounce equals 23 almonds, so keep track of the count.)
  5. Enjoy soy. Replace your weekend pork sausage patty with a meatless patty at breakfast. Stir-fry firm tofu with vegetables. Snack on cooked edamame (soybeans in their pods). Sip on a cool glass of soymilk with meals.
  6. Supplement with plant sterols. Approximately 2 grams of plant sterols, when added to a heart-healthy diet, help to lower cholesterol. Look for plant-sterol-enriched margarines, orange juice, milk, breads, muffins and cheese.
  7. Move to monounsaturated fats. Replace those unhealthy fats in your diet to eat more like those in the Mediterranean. Slice some avocado onto a sandwich. Use olive oil to sauté vegetables or in your salad dressing. Slice olives into salads. Snack on a small serving of nuts.

Melissa Ohlson, RD, LD, is a registered dietitian in the Department of Preventive Cardiology and Rehabilitation in Cleveland Clinic’s Heart & Vascular Institute.

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Recipe: Pumpkin Ravioli in a Wild Mushroom-Ginger Broth

Ravioli filled with this savory mousse will delight your family and friends. The pumpkin says that fall has arrived and luckily for us, canned pumpkin puree is always available. Use a mélange of wild mushrooms in the broth. We like thinly sliced cremini, shiitakes, chanterelles and morels. Because some of these are hard to find, we buy dried and reconstitute them. You can use other winter squashes or sweet potatoes for the filling.



  • Refrigerated butter-flavored cooking spray
  • 1 shallot, minced
  • ¾ cup pumpkin puree
  • ¼ cup egg substitute
  • 2 tablespoons reduced-fat ricotta cheese
  • 2 teaspoons minced fresh sage
  • 1/8 teaspoon ground nutmeg
  • Freshly ground pepper
  • 32 won ton wrappers (3.5-inch square), defrosted if frozen
  • Kosher salt

Wild Mushroom-Ginger Broth

  • 3 cups fat-free, reduced-sodium chicken broth
  • 1 ounce dried wild mushrooms, rehydrated (see Note)
  • ½ pound assorted wild mushrooms, thinly sliced
  • 2 teaspoons grated fresh ginger
  • 1 garlic clove, crushed
  • 2 scallions, white parts and 3 inches of the green, thinly sliced
  1. Coat a nonstick skillet with cooking spray. Saute the shallot over medium heat until wilted, about 5 minutes. Remove from heat. In a bowl, combine the pumpkin puree, egg substitute, ricotta cheese, sage and nutmeg. Stir in the shallot and pepper. Set aside.
  2. Place 8 won tons on the counter and put 1 tablespoon of the pumpkin mousse in the middle of each. Wet the edges of the won ton and place another on top, pressing all around the edges to seal securely. Leave square or cut with a floured glass to make a circle, again making sure that each ravioli is sealed. Place on wax paper and cover with a clean kitchen towel. Place another 8 won tons on the counter and repeat the process. If not cooking immediately, transfer to a cookie sheet, cover and refrigerate.
  3. To make the broth, combine the chicken broth, rehydrated and fresh mushrooms, ginger and garlic in a saucepan, bring to a boil, then simmer for 10 minutes. Set aside and keep warm.
  4. To cook the ravioli, bring a large pot of lightly salted water to a boil. Reduce to a simmer. Slide in half of the ravioli one at a time and stir gently. Poach for 2 to 3 minutes, until the ravioli rise to the top of the pot. Remove with a slotted spoon and cook the remainder of the ravioli.
  5. While the ravioli are cooking, bring the ginger broth back to a simmer.
  6. To serve, place 4 ravioli in each of 4 shallow soup bowls. Ladle ¾ cup broth into each soup bowl. Top with a quarter of the mushrooms and garnish with sliced scallions. Serve immediately.

NOTE: To rehydrate dried mushrooms, soak the mushrooms in boiling water to cover for about 15 minutes, or until softened. Remove the mushrooms with a slotted spoon. Strain the soaking liquid through a coffee filter to remove sediment. Use in the recipe or reserve for another use.

DIETITIAN’S NOTE: Although this dish contains about 100 milligrams more sodium than we generally recommend at a meal, it is a good source of potassium, contains dietary fiber, and is low in total fat. Just make sure you monitor the sodium content in your other meals, and serve the ravioli with a side of fresh vegetables.

Nutrition Information

Makes 4 Servings

Per Serving:

  • 280 calories (5% calories from fat)
  • 1.5 g total fat (0 g saturated fat)
  • 13 g protein
  • 55 g carbohydrate
  • 4 g dietary fiber
  • 10 mg cholesterol
  • 700 mg sodium
  • 657 mg potassium

This heart-healthy recipe and more than 150 others are available from the nation’s #1 heart center in the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook (© 2007 Broadway Books). The cookbook is available in bookstores or online from, or

Children's Health Essentials – February 2011 Issue

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