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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


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


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

Learn more

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.