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Assessing infants with suspected cow’s milk allergy

The International Milk Allergy in Primary Care (iMAP) guideline encourages early recognition of CMA, and emphasises the need to confirm or exclude the possible diagnosis1

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

However, infants presenting with severe symptoms should be referred to the local paediatric allergy service (non-IgE-mediated) or receive emergency treatment for anaphylaxis (IgE-mediated).1

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Recognise symptoms and perform physical examination

Symptoms of mild-to-moderate CMA are very common in otherwise well infants (e.g. vomiting and colic), so clinical judgement is required.1

There should be increased suspicion of CMA if multiple, persistent, severe or treatment-resistant symptoms are present.1

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Take a thorough allergy- focused clinical history

Due to the common nature of some symptoms, this has been referred to as the ‘cornerstone of diagnosis’ by the iMAP guideline, including:1,3

  • - Family history of atopic disease
  • - Sources of cow’s milk protein
  • - Presenting symptoms
  • - Details of feeding difficulties and/or poor growth
 
 

If the physical examination and clinical history both strongly suggest CMA, then an allergy test (suspected IgE-mediated CMA) or an elimination and reintroduction trial of dietary cow’s milk protein (suspected mild-to-moderate non-IgE-mediated CMA) are needed to confirm diagnosis.1,3

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IMPORTANT NOTICE: Breastfeeding is best for infants and is recommended for as long as possible during infancy. Alimentum and EleCare are infant formulas for special medical purposes and should only be used under the recommendation or guidance of a healthcare professional.

CMA: cow’s milk allergy; IgE: immunoglobulin E; iMAP: International Milk Allergy in Primary Care.

 

References

UK-SIMILAC-2000016 December 2020