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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

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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:

Eczema

50% increased risk of eczema7

Infection

260% increased risk of hospitalisation for lower respiratory infection8

Inflammation

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

Allergies

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.

References