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Managing cow’s milk allergy

This section covers the latest recommendations from international guidelines on how to identify, diagnose and support infants with CMA as early as possible


Identifying initial presentation of CMA

CMA is an immune-mediated response to proteins in cow’s milk that can be IgE-mediated or non-IgE-mediated, depending on how the immune system reacts.1,2 Both types can present diverse clinical symptoms, which can vary in severity and speed of onset.1,2

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Assessing infants with suspected CMA

The international guidelines encourage early recognition of CMA, which should be achieved through a physical examination and taking a thorough allergy-focused clinical history.2-4

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Diagnosing and managing infants with suspected CMA

The diagnosis of suspected CMA can only be confirmed or excluded by an allergy test or a reintroduction trial of dietary cow’s milk protein.2,4

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Without the protective benefits of breast milk, formula-fed infants with CMA are more vulnerable to immune challenges, particularly in the first year of life2,5–9

Compared with exclusively breastfed infants, formula-fed infants face higher risks of:


50% increased risk of eczema7


260% increased risk of hospitalisation for lower respiratory infection8


Significantly elevated TNF-α and IL-2 serum levels (both p=0.002)5


CMA symptoms present in up to 7% of all infants vs 0.5% breastfed infants2,9

Formula-fed infants with CMA consume additional healthcare resources compared with formula-fed infants without CMA:

More hospital admissions6

(13% vs 5%)*†

More GP appointments6

(mean: 4.7 vs 3.1)*‡

More visits to out-of-hours care6

(24% vs 15%)

IMPORTANT NOTICE: Breastfeeding is best for infants and is recommended for as long as possible during infancy. 

CMA: cow’s milk allergy; IgE: immunoglobulin E.