Cow's milk protein intolerance/allergy

Question 1

what age range does it occur in?

Answer 1

first 3 months of life in formula-fed infants

Question 2

what antibody is immediated?

Answer 2

Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions are seen

The term CMPA is usually used for immediate reactions and CMPI for mild-moderate delayed reactions.

Question 3

features

Answer 3

regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
‘colic’ symptoms: irritability, crying
wheeze, chronic cough
rarely angioedema and anaphylaxis may occur

Question 4

diagnosis

Answer 4

skin prick/patch testing
total IgE and specific IgE (RAST) for cow’s milk protein

Question 5

management if formula fed

Answer 5

extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms

amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF

around 10% of infants are also intolerant to soya milk

Question 6

management if breastfed

Answer 6

continue breastfeeding

eliminate cow’s milk protein from maternal diet.

Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet

use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months

Question 7

prognosis

Answer 7

most resolve