Ask the Dietitian…

“My wife had a baby 2 months ago & we just found out he has a milk allergy. His skin rash cleared up when he went on special formula but it’s soooo expensive! $50 per can and we just can’t afford it. Please help!”

Having an infant with a cow’s milk protein allergy can be tough! There are special formulas out there but they can be expensive, especially as the infant keeps growing & needing to drink more and more formula.  

So… what’s going on here? 

When a person has a cows milk protein allergy, it means that their immune system is confused & goes on the attack when a certain protein in milk is present. 

There are two types of allergy: 

1. IgE Mediated (60% of cases) — most common food allergy in infants, followed by peanuts and tree nuts. Symptoms usually appear a few minutes to hours after ingestion. Common symptoms are hives/rash, difficulty breathing, wheezing, eye irritation, trouble breathing, vomiting, nausea, abdominal bloating, diarrhea, or in severe cases a life-threatening drop in blood pressure. You should call 911 immediately if your child develops 2 or more of these symptoms.  

2. Non-IgE Mediated — less common and typically shows up in the gastrointestinal tract (stomach + intestines). The symptoms are pain, flatulence, diarrhea and bloody stools. 

It’s important to note that many children with a dairy allergy will also react to soy products. Just something to look out for!

How do I know if my child has a cows milk protein allergy? 

Diagnosis is not always straightforward. What usually happens is when symptoms appear, the pediatrician recommends changing to a dairy-free formula. If the symptoms go away, then that is taken as confirmation of a dairy allergy.

Some pediatricians will refer to an allergist, who will likely do a skin prick test to determine what causes a reaction. Please be aware that other conditions can cause similar symptoms (for example, we thought my son’s eczema was caused by a dairy/soy allergy for a YEAR but turns out it’s purely skin-related and now well-controlled by monoclonal antibody shots). Your doctor may also order a blood test to determine what foods the antibodies react to, which tells them what the body is perceiving as a threat. 

So what do I feed my infant who has a milk allergy?

Luckily there are lots of options for milk protein-free formulas. To help with the cost, several manufacturers have coupons or reimbursement programs available. Additionally, both WIC and SNAP have dairy-free formulas available. Finally, if you are willing to be persistent, there are ways to get your insurance company to cover the special formula. 

Option 6 is my top recommendation because it is both dairy & soy free, and lowest cost. 

Options 4-5 are the next best (dairy + soy free; reimbursement available). 

1. EleCare from Abbott Health

This is a commonly prescribed special formula. It is nutritionally complete but does contain soy oil. 

Average $50 per 14 oz can (which lasts about 3 days with a 2 month old; less time for older babies). That cost adds up! ($3.57 per oz)

Cost assistance available through their Pathway Plus program. Call 1-855-217-0698 to get the process started. 

2. Enfamil Nutramigen

Extensively hydrolyzed formula (means the proteins are broken down into their building blocks, which 90% of infants with CMPA can tolerate)

Slightly cheaper — $38 for 12 oz can ($3.17 per oz)

Find out about Enfamil's reimbursement program here: https://www.enfamil.com/reimbursement-support/ 

3. Similac Alimentum

SNAP eligible

$36 for 12 oz ($3.00 per oz)

Walmart has 19 oz can for $52 online ($2.73 per oz)

4. Nutricia Neocate

Dairy & soy free

$45-50 for 14 oz ($3.21 per oz)

Available at CVS and Walgreens 

Reimbursement program - https://www.neocate.com/reimbursement/

Nutricia provides a sample Letter of Medical Necessity to get insurance help. You can download it from their website as a Word doc here but this letter can be used for ANY formula! Just have your pediatrician complete it & change the formula name if necessary.

5. Nutricia Pepticate

Dairy & soy free

$40 for 14 oz ($2.85 per oz)

Reimbursement program - https://www.neocate.com/reimbursement/

Letter of Medical Necessity to get insurance help.

6. Alfamino Extensive HA (my top pick! No affiliation.)

Dairy & soy free

$36 for 14 oz ($2.57 per oz)

You can request samples! 

How do I get insurance to help with the cost? 

BE THE SQUEAKY WHEEL! Have your pediatrician submit the Letter of Medical Necessity (link above) to request coverage as Durable Medical Equipment. This letter can be used for ANY formula, just change the formula name. You may have to call your insurance company several times and jump through hoops, but it’s worth it to get assistance.