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