Cows milk protein allergy management Flashcards
What is the onset time for IgE-mediated cow’s milk protein allergy (CMA)?
IgE-mediated CMA onset is within minutes (up to 2 hours) of ingestion.
What should be done for mild to moderate IgE-mediated CMA?
For mild to moderate IgE-mediated CMA, allergy testing at a specialist allergy clinic and paediatric dietician referral should be done.
What dietary advice should be given to an exclusively breast-feeding mother with a baby who has IgE-mediated CMA?
An exclusively breast-feeding mother should exclude all cow’s milk protein from her diet and take calcium and vitamin D supplements.
What formula should be tried for formula-fed or mixed-fed infants with mild to moderate IgE-mediated CMA?
For formula-fed or mixed-fed infants, trial extensively hydrolysed formula.
What additional steps should be taken for severe IgE-mediated CMA?
For severe IgE-mediated CMA, consider elemental (amino acid) formula if extensively hydrolysed formula is not effective and refer to A&E if severe respiratory or CVS signs are present.
What is the onset time for non-IgE-mediated cow’s milk protein allergy (CMA)?
Non-IgE-mediated CMA onset is 2-72 hours after ingestion.
What caution should be taken when diagnosing infants with non-IgE-mediated CMA?
Be wary of diagnosing infants with CMA as GI symptoms of vomiting and diarrhoea are very common.
What should an exclusively breast-feeding mother do if her baby has mild to moderate non-IgE-mediated CMA?
Exclude all cow’s milk protein from the mother’s diet for 2-4 weeks, followed by home reintroduction of cow’s milk to confirm diagnosis if there is clear symptom improvement. Mother should take calcium and vitamin D supplements.
What formula should be tried for formula-fed or mixed-fed infants with mild to moderate non-IgE-mediated CMA?
Trial extensively hydrolysed formula.
What classifies non-IgE-mediated CMA as severe?
Non-IgE-mediated CMA is classified as severe if symptoms persist and are severe despite the above measures. Symptoms include pruritis, erythema, atopic eczema, GORD, vomiting, loose stools, blood or mucus in stools, abdominal pain or discomfort, infantile colic, food refusal or aversion, constipation, perianal redness, pallor or tenderness, faltering growth, cough, chest tightness, wheezing, and shortness of breath.
What additional management steps should be taken for severe non-IgE-mediated CMA?
Continue management as per mild/moderate non-IgE-mediated CMA plus urgent referral to local paediatric allergy service and dietician.
How long should a cow’s milk-free diet be advised for a child with non-IgE-mediated CMA?
Advise a cow’s milk-free diet until the child is 9-12 months old and for at least 6 months if non-IgE-mediated allergy is confirmed. After which, commence a milk ladder for home reintroduction of cow’s milk to assess whether tolerance has been acquired.
What should be done for weaned infants or older children with cow’s milk protein allergy?
Exclude cow’s milk protein from their diet, offer nutritional counselling with a paediatric dietician, regularly monitor growth, and re-evaluate the child to assess for tolerance to cow’s milk protein every 6-12 months.
How often should children with cow’s milk protein allergy be re-evaluated for tolerance?
Children with cow’s milk protein allergy should be re-evaluated for tolerance every 6-12 months.
What is the ‘Milk Ladder’ used for in the context of cow’s milk protein allergy?
The ‘Milk Ladder’ is used for reintroducing cow’s milk protein into the diet to assess whether tolerance has been acquired.