- Non IgE mediated CMPA can present with a wide range of symptoms which are common in infants and can be related to causes other than allergy, e.g. Irritability (colic), gastro-oesophageal reflux, rashes and atopic dermatitis.
- In breast fed infants the incidence of CMPA is less than 0.5% compared to 3-5% in formula fed infants5, 6, 7.
- Healthcare professionals should reinforce the importance of breast feeding, in line with the World Health Organisation Guidelines8 , and be aware of the negative psychological effect of an elimination diet. Unnecessary elimination of food allergens may adversely impact on the quality of life and nutritional status of the breast feeding mother.
- The diagnosis should only be made:
- after undertaking a thorough allergy focused history and consideration of other first line management e.g general infant feeding advice, management GORD and eczema
- after exclusion of milk and milk products for 2-4 weeks followed by a planned reintroduction
- reoccurence of the symptoms when milk and milk products are reintroduced after a 2-4 week period of strict exclusion
- Cow’s milk allergy will resolve in the majority of children by around 12 months of age and infants should be reassessed by a dietitian at 6-12 monthly intervals after diagnosis to consider reintroduction cow’s milk/milk products using the milk ladder.
- Extensively hydrolysed formulas (eHFs) are the recommended therapeutic choice and are tolerated by the majority of infants and children (90%) with cow's milk protein allergy.
- The choice of amino acid formulas (AAF) instead of eHF should be made based on the history and combination of symptoms rather than on absolute indication (based on a single condition or a specific symptom). AAF should be offered when eHF fails, in growth faltering babies, in particular those with multisystem involvement (gastrointestinal tract and / or skin), multiple food eliminations and history of anaphylaxis. The initiation of an AAF formula ideally should be discussed with the general paediatric and / or dietetic team.