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Symptoms and diagnosis of CMA

Signs and symptoms

The symptoms of food allergy can manifest in the skin, gastrointestinal system and respiratory system. The NICE guidelines on diagnosis of food allergy in children list the following key signs and symptoms.1

  • Pruritus
  • Erythema
  • Atopic eczema
Gastrointestinal system
  • Angioedema of lips, tongue, palate
  • Oral pruritus
  • Nausea
  • Colicky abdominal pain
  • Vomiting
  • Diarrhoea
  • Gastro-oesophageal reflux disease
  • Loose or frequent stools
  • Blood or mucus in stools
  • Abdominal pain
  • Colic
  • Food refusal or aversion
  • Constipation
  • Perianal redness
  • Pallor or tiredness
  • Faltering growth
Respiratory system§
  • Upper respiratory tract symptoms
  • Lower respiratory tract symptoms
  • Lower respiratory tract symptoms
  • † This is not an exhaustive list, and absence of these symptoms does not exclude food allergy
  • ‡ In conjunction with one or more gastrointestinal symptoms
  • § Usually in combination with one or more skin or gastrointestinal symptoms

In practice, infants with CMA present with a spectrum of symptoms, often affecting more than one of these three organ systems2. Recognising patterns and overlap among symptoms can be key to identifying children with food allergy.

Assessment and diagnosis

Patients with mild but persistent allergy symptoms are usually diagnosed and managed in primary care, without referral to a specialist service.1

  • Assessment and diagnosis of CMA in primary care are guided by recommendations from NICE and the RCPCH.1,3
  • Following an initial assessment, a diagnosis of CMA can be confirmed with one or more tests, as determined by the suspected underlying mechanism of allergy.1

The NICE guidelines: key steps in diagnosis and assessment of food allergy in children and young people1

Recognise the signs and symptoms of potential allergy
Take a thorough allergy-focused history and physically examine1 the child
Consider referral, based on key criteria
Information and support
Offer age-appropriate information relevant to the type of allergy
(IgE-mediated, non-IgE-mediated or mixed)
Include the risk of severe reactions, the diagnostic process and support groups
Suspected IgE-mediated allergy
Offer skin prick tests or specific
IgE blood tests

Tests should only be undertaken by a healthcare professional with appropriate competencies and only where there are appropriate facilities to deal with an anaphylactic reaction

Suspected non-IgE-mediated allergy
Consult a dietitian with appropriate competencies for dietary advice
Suggest an elimination diet for 2–6 weeks followed by an oral food challenge

Show references
  1. National Institute for Health and Clinical Excellence. CG116: Food allergy in children and young people. 2011.

  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. Royal College of Paediatrics and Child Health. Allergy care pathways for children: food allergy. 2011.