Cow’s Milk Protein Allergy (Cmpa)

1. Cow’s Milk Protein Allergy (Cmpa)

• • Two types: IgE-mediated and non-IgE mediated
  • Non-IgE is most common in primary care
  • Associated with atopic conditions: eczema, asthma, other food allergies

Symptoms

• IgE-mediated (<2 hours):
• GI: vomiting, diarrhoea, colic, abdominal discomfort
• Skin: acute pruritus, urticaria, erythema, atopic dermatitis flares • Respiratory: wheezes, coughs
• Non-IgE mediated (2-72 hours):
• GI: GORD-like symptoms, reflux, vomiting, colic, diarrhoea with mucus/blood
• Skin: pruritus, erythema, nonspecific rash

Diagnosis 

• IgE-mediated: skin prick test, IgE serum blood samples
• Non-IgE mediated: elimination-reintroduction test (2-4 weeks)

Management 

• First line: exclusive breastfeeding
• If breastfeeding: maternal cow’s milk-free diet with calcium/vitamin D supplementation
• Formula options:
• Hydrolysed formulas: Aptamil Pepti 1/2, SMA Althera
• Amino acid formulas (secondary care initiation)
• Continue a cow’s milk-free diet for a minimum of 6 months post-diagnosis
• Review at 9-12 months for reintroduction
• Soy milk is suitable for>6 months (not preferred)

Referral Criteria 

• Multiple GI symptoms with faltering growth
• Acute systemic reactions/anaphylaxis
• Severe atopic dermatitis
• Multiple food allergies
• Strong parental suspicion with IgE-mediated symptoms
• Concurrent asthma