Infant formulas for milk allergies

Milk and formula-induced allergies may present with rash, vomiting, wheezing, and/or cough.  Cow's milk allergy is the usual cause.

Studies show that 10-14% of infants with cow's milk allergy also have a reaction to soy.

There are also a few infants and children who do have traditional milk allergy but instead have a non-IgE reaction to milk. Around 40 percent of those children also have a reaction to soy.

The majority of infants are likely to tolerate soy. This allows most milk-intolerant infants to use soy formulas safely and with less expense than specialized formulas.

This differs from some organizations' recommendations to use an extensively hydrolyzed casein formula. These expensive formulas are an option for those who do not wish to use soy.

In the past, there has been concern about the phytoestrogens contained in soy husks; however, studies have shown that this weak estrogen has not made any difference in sexual development or fertility for adults decades later who were raised on soy formulas. 

When there is a strong family history of allergy, your physician may wish to try an extensively hydrolyzed casein formula first or after a soy formula trial. 

For toddlers who do not tolerate cow's milk, soy milk is an excellent option.

It has the most protein of all the alternative milks (see the table below). A toddler who is unable to tolerate soy milk or has an allergy to it, the other alternative milks can be tried but parents must be sure the diet also contains good sources of dietary protein.

Adapted from An Evidence-Based, Cost-Sensitive Infant Formula Algorithm for the Infant on Georgia's WIC Program

Stanley A Cohen and Kylia Crane RD, 2013