Paeds: CMPA

Question 1

Cow’s milk is a good source of:

Answer 1

Cow’s milk is a good source of:
* Calcium
* Vitamin D
* Energy
* Protein
* Fat
* Fat soluble vitamins
* Iodine
* Magnesium
* Phosphorous
* B Vitamins

Question 2

What is cows milk protein allergy?
What are the different forms?

Answer 2

• Cow’s milk protein allergy is an an immune system response to proteins found in cow’s milk, primarily casein and whey.
• The allergy can be IgE mediated or non-IgE mediated.

Question 3

Is the prevalence of non-IgE mediated CMPA well documented?

Answer 3

According to Skypala & Meyer the prevalence of non-IgE mediated CMPA is not well documented

Question 4

According to Allergy UK, CMP is the ? most common food allergen to cause anaphylaxis.

Answer 4

According to Allergy UK, CMP is the 3rd most common food allergen to cause anaphylaxis .

Question 5

What is atopy?

Answer 5

Atopy:
Genetic predisposition to develop exaggerated immune responses to common allergens

Question 6

Is the prognosis of CMPA good?

Answer 6

Yes, the prognosis for CMPA is good. 80-90% of sufferers will develop tolerance by 3yo.

Question 7

IgE mediated CMPA is ? in adulthood

Answer 7

IgE mediated CMPA is rare in adulthood

Question 8

Possible advice/intervention for CMPA

Answer 8

Possible advice/intervention for CMPA
* Alternative formula milks/ breastfeeding advice
* Food label understanding
* Travelling
* Alternative words for “milk protein” e.g. casein, whey
* Management at school/nursery
* Additional resources: Allergy UK, Anaphylaxis campaign
* Effect on diet/nutritional status if food is excluded
* ‘May contain’ advice
* Milk challenge, Baked milk?
* Carriage of Epi Pen or allergy medication?

Question 9

The European Society of Paediatric Gastroenterology Hepatology & Nutrition (ESPGHAN) guidelines for CMPA

Answer 9

The European Society of Paediatric Gastroenterology Hepatology & Nutrition (ESPGHAN) guidelines for CMPA
* Diagnosis: elimination diet followed by an oral food challenge
* Breastfed: may react to protein from mother’s diet. CMP can be found in breastmilk hours-days after ingestion. However a study found (Munbilit et al.) that the CMP content in breast milk was insufficient to cause an allergic reaction.
* ESPGHAN advice for breastfeeding mothers: not usually necessary to exclude CMP from diet.