Diagnosing and managing infants with suspected cow’s milk allergy

Allergy testing should be used to diagnose suspected IgE-mediated CMA, whereas exclusion and reintroduction of dietary cow’s milk should be used to confirm suspected non-IgE-mediated CMA^1–3

Confirming the diagnosis of suspected IgE-mediated CMA

Infants presenting with mild-to-moderate symptoms should be diagnosed and managed in primary care without referral to a specialist service.^1,2

If the clinical history suggests IgE-mediated CMA, cow’s milk protein should be eliminated from the infant’s diet (and from the mother’s diet, if necessary), and the infant must be referred to secondary care or an allergy referral centre for IgE antibody testing.^1,3

• • A supervised challenge should only be carried out if the IgE testing is inconclusive³

Initial testing should be followed-up with serial IgE testing and later a planned challenge to test for acquired tolerance.^1–3

Confirming the diagnosis of suspected non-IgE-mediated CMA

If non-IgE-mediated CMA is suggested by the clinical history, and no severe reaction has been observed, a diagnosis of suspected mild-to-moderate CMA should be confirmed by a trial of elimination and reintroduction of cow’s milk protein in the infant’s diet.^1–3

Infants who present with severe symptoms should be managed by eliminating cow’s milk protein from their diet and must be referred to the local paediatric allergy service.^1,3

Useful Resources

Please see ‘The iMAP Home Reintroduction’ tool for parents and carers on the GP Infant Feeding Network (UK) webpage.

The iMAP guideline also advises on the length of the diet before cow’s milk protein can be gradually trialled back into the infant’s diet to test for the expected acquisition of tolerance over time – download the iMAP Milk Ladder.