Cows Milk Protein Allergy

Non IgE-mediated CMPA (delayed) symptoms

Occurs within 2-72 hours of ingestion

  • Red flags – blood/mucus in stools, vomiting, faltering growth, severe eczema
  • GI – colic, vomiting, reflux, constipation, loose stools, food refusal, blood/mucus in stools, faltering growth
  • Skin – itching, redness, eczema
  • Respiratory – rhinitis

IgE-mediated CMPA (acute) symptoms

  • Red flags – anaphylaxis
  • GI – diarrhoea/vomiting, abdominal pain
  • Skin – acute itching, erythema, urticaria, angioedma
  • Respiratory – rhinitis


Clinical management

  • Investigations
    • Avoid initial IgE blood tests
  • Treatment
    • If breast fed
      • Mum to exclude all cow’s milk and soya from her diet and to take daily calcium (1000mg) + vitamin D (10mcg/400 IU) supplements
      • Most symptoms should settle within 2-4 weeks
    • If formula fed
      • First line: Extensively hydrolysed formula e.g. Nutramigen
        • Nutramigen 2 when child is >6 months old
      • Second line: Amino Acid Formula e.g. Neocate LCP
    • Refer to paediatrics
      • Confirmation of diagnosis
      • Dietician
      • Planned and supervised reintroduction
  • Follow-up / Safety-net
    • Will need to continue with cow’s milk free diet until 9-12 months and then a planned reintroduction using the milk ladder will need to be done