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Identifying cow's milk allergy

Cow’s milk allergy (CMA) is an immune-mediated response to proteins in cow’s milk.1
CMA symptoms present in up to 7% of all infants and 0.5% of breastfed infants2,3

CMA is either IgE-mediated or non-IgE-mediated (or a mix of both), which can be distinguished by symptoms and speed of symptom onset:1,2

  • IgE-mediated: symptoms usually occur within minutes to up to 2 hours after ingestion
  • Non-IgE-mediated: symptoms usually occur 2–72 hours after ingestion

CMA usually involves multiple systems - key symptoms include:*2

IgE-mediated CMA


  • Vomiting
  • Abdominal pain
  • Diarrhoea
  • Colicky abdominal pain/discomfort
  • Angio-oedema of the lips, tongue and palate
  • Oral pruritus


  • Pruritus
  • Erythema
  • Acute urticaria
  • Acute angio-oedema
  • Atopic eczema


  • Acute rhinitis
  • Conjunctivitis


  • Anaphylaxis

Non-IgE-mediated CMA


  • Vomiting
  • Abdominal pain
  • Diarrhoea
  • Infantile colic/persistent irritability
  • Constipation
  • Food refusal
  • Blood/mucus in stool
  • Faltering growth


  • Pruritus
  • Erythema/flushing
  • Atopic eczema

Both IgE- and non-IgE-mediated CMA can present with mild-to-moderate or severe symptoms.1,2 Some of the symptoms listed above are very common in otherwise well infants, particularly in those with mild-to-moderate CMA symptoms.2,4

Because of this, a diagnosis can only be considered if the initial assessment (physical examination and allergy-focused clinical history) strongly suggests CMA.2,4

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

*This is not an exhaustive list of CMA symptoms. Absence of these symptoms does not exclude CMA.

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