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This website is intended for healthcare professionals and contains information about Mead Johnson Nutrition special infant formulas.

Important Notice: Breast feeding provides the best nutrition for babies. Mead Johnson special formulas are intended for bottle-fed infants and are Food for Special Medical Purposes (FSMPs) and must be used under medical supervision.

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Management of CMA

Key recommendations

Clinical guidelines recommend extensively hydrolysed formulas (eHFs), such as Nutramigen LIPIL, as the first-line choice for the majority of infants with mild-to-moderate CMA.1,2

Amino acid-based formulas (AAFs), such as Nutramigen PURAMINO, are recommended for severe CMA and multiple food allergies or when an eHF is ineffective.1,2

Soya formula is not recommended for CMA, and should only be used in exceptional circumstances.6,7

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A number of international and EU bodies have published guidelines to support effective management of CMA.1–7

Summary of EU and international guidelines on dietary management of CMA

Exclusively breast-fed infants

A strict elimination of the causal protein from the diet of the lactating mother should be tried.1–4

Bottle-fed infants

Mild-to-moderate cow’s milk allergy

Extensively hydrolysed formulas (eHFs) with proven efficacy are usually the first-choice of hypoallergenic formula for at least 90% of formula-fed infants with mild-to-moderate cow’s milk allergy.2,8,9

Severe/multiple food allergies

Amino acid-based formulas (AAFs) are recommended in the remaining ~10% of infants with severe CMA and multiple food allergies. AAFs are also recommended if a child does not settle on an eHF or as a top-up to breast milk.2,10

AAFs are recommended for:2,10

           - Severe cow's milk allergy
           - Multiple food allergies
           - Other indications requiring an elemental diet

Short-term objective = avoidance of complete cow’s milk protein to manage symptoms

  • eHFs contain cow’s milk proteins (CMPs) broken down into short chains and 'individual' amino acids. This means that eHFs don’t contain whole CMP. The short chains and amino acids are usually not recognised as harmful and therefore do not trigger allergic reactions in most cases

  • AAFs contain 100% individual amino acids. This means that only amino acids are present, which are not recognised as harmful and therefore are very unlikely to trigger allergic reactions

  • In weaned infants, all other food containing CMP should be strictly avoided

Infants with moderate to severe atopic eczema

Bottle-fed babies who are suspected of having a food allergy should be offered a 6–8 week trial of an eHF or an AAF.5

Goat's or sheep's milk and partially hydrolysed formulas

These are not hypoallergenic and should not be used for the management of CMA.2-4

Soya-based formulas

Contain high phytate, aluminium and phytoestrogen concentrations, the long-term effects of which are unknown. These formulas should not be used in infants with CMA during the first 6 months of life, and should not be the first choice thereafter.6,7 Read more

Show references
  1. Fiocchi A, Brozek J, Schunemann H et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organization Journal 2010;3:57-161.

  2. Vandenplas Y, Koletzko S, Isolauri E et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 2007;92:902-8.

  3. Du Toit G, Meyer R, Shah N et al. Identifying and managing cow's milk protein allergy. Arch Dis Child Educ Pract Ed 2010;95:134-44.

  4. Host A, Koletzko B, Dreborg S et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999;81:80-4.

  5. National Institute for Health and Clinical Excellence. CG57: Atopic eczema in children. 2007.

  6. Agostoni C, Axelsson I, Goulet O et al. Soy protein infant formulae and follow-on formulae: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2006;42:352-61.

  7. Department of Health. CMO's Update 37: Advice issued on soya-based infant formulas. 2004.

  8. Dupont C et al. Dietary treatment of cows’ milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics. Br J Nutr 2012;107:325–38.

  9. Koletzko S et al. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI committee practical guidelines. J Pediatr Gastroenterol Nutr 2012;55:221­–229.

  10. Venter C et al. Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy – a UK primary care practical guide. Clin Transl Allergy 2013;3:23.