Cow's milk protein intolerance/allergy

Question 1

What is the epidemiology of CMPI/A?

Answer 1

3-6% OF ALL CHILDREN
Occurs in the first 3 months
Usually in formula fed children, rare in breastfed

Question 2

Features of CMPI/A

Answer 2

1. regurgitation and vomiting
2. diarrhoea
3. urticaria, atopic eczema
4. ‘colic’ symptoms: irritability, crying
5. wheeze, chronic cough
6. rarely angioedema and anaphylaxis may occur in allergy

Question 3

What investigations are done for diagnosis?

Answer 3

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

Question 4

Management if formula fed

Answer 4

1. extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms
2. amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF

Question 5

Management if breast fed

Answer 5

1. Continue breastfeeding
2. Eliminate cow’s milk from mother’s diet but prescribe calcium supplements
3. Use extra hydrolysed formula milk when breast feeding stops - until 12 months of age

Question 6

When will the child be milk tolerant?

Answer 6

in children with IgE mediated intolerance around 55% will be milk tolerant by the age of 5 years

in children with non-IgE mediated intolerance most children will be milk tolerant by the age of 3 years