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What is CMA?

Fast facts

  • CMA is the most common type of food allergy in infants, affecting between 2% and 7.5% of all infants1,2 Read more
  • It is caused by an immune reaction to one or more of the proteins in cow’s milk3
  • CMA can have a profound impact on quality of life for patients and their families, which should not be underestimated4
  • Nonetheless, it is usually a temporary condition – as many as 87% of children grow out of it by 3 years of age5

Classification of adverse reactions to cow’s milk6

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CMA or lactose intolerance?

CMA is often confused with lactose intolerance, but they are two distinct conditions.1,6

  • CMA is an immune reaction to proteins in cow's milk
  • Lactose intolerance is a non-immune condition, in which people cannot digest the milk sugar, lactose.1,6 However, some CMA patients may also have concomitant lactose intolerance.
  • Both conditions may lead to digestive problems such as diarrhoea, bloating and wind, but rashes, eczema, and breathing difficulties are only seen in CMA.6
  • Like CMA, lactose intolerance is managed by avoiding milk and dairy products.

Lactose-free formula and dairy products are widely available; however these are not suitable for children with CMA as they contain whole cow’s milk protein and so are not hypoallergenic. Read more

IgE- and non-IgE-mediated CMA

Although it is often thought of as a single condition, CMA is in fact driven by two distinct immune pathologies, referred to as IgE-mediated allergy and non-IgE-mediated allergy.1

IgE-mediated allergy
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Non-IgE-mediated allergy
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IgE-mediated allergy is often referred to as an ‘immediate-onset reaction’, as symptoms appear rapidly after exposure to an allergen (within 2-4 hours).1 In severe cases, IgE-mediated reactions may result in potentially life-threatening anaphylaxis.1

Non-IgE-mediated, or ‘delayed-onset’ reactions tend to appear up to 48 hours or even days after consuming dairy products.1

  • Some reactions may involve a mixture of the two and are referred to as ‘mixed IgE and non-IgE allergy'.1
Show references
  1. 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.

  2. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 2007;120:1172-7.

  3. 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.

  4. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010;65:933-45.

  5. Host A, Halken S, Jacobsen HP et al. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 2002;13 Suppl 15:23-8.

  6. Crittenden RG, Bennett LE. Cow's milk allergy: a complex disorder. J Am Coll Nutr 2005;24:582S-91S.