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

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Cow’s milk allergy

1. How is CMA typically diagnosed and managed?

Diagnosis begins with obtaining an allergy-focused personal and familial history. This should provide an indication of whether any suspected allergy is IgE- or non-IgE-mediated.1 This is followed by a physical examination and one or more tests (skin prick test or blood test if IgE-mediated allergy is suspected; diagnostic elimination diet followed by oral challenge if non-IgE-mediated allergy is suspected).1 Learn more

Confirmed CMA should be managed with an elimination diet. For exclusively breast-fed infants, this involves strict elimination of cow’s milk protein from the mother’s diet.2–5 Formula-fed infants with mild-to-moderate CMA should receive an eHF such as Nutramigen LIPIL;3,5 an AAF such as Nutramigen PURAMINO should be used for severe CMA and multiple food allergies.3,4 Learn more

Adapted from Koletzko et al.6

2. Can colic be a symptom of CMA?

Infantile colic is a recognised symptom of CMA.7 In breast-fed infants, colic has been shown to be related to consumption of dairy products by the mother.7 Similarly, colic in bottle-fed babies may be caused by an allergic reaction to the cow’s milk protein found in routine formula.7 Consequently, NICE guidelines on postnatal care recommend that a hypoallergenic formula, such as Nutramigen LIPIL, can be a helpful treatment for bottle-fed babies with colic.8 Learn more

3. Is CMA the same as lactose intolerance?

CMA is often confused with lactose intolerance, but they are actually two distinct conditions and are managed differently.4,9 CMA is an immune reaction to proteins in cow’s milk, whereas lactose intolerance is a non-immune condition, in which people cannot digest the milk sugar, lactose.4,9 Both conditions may lead to digestive problems such as diarrhoea, bloating and flatulence, but rashes, eczema, and breathing difficulties are only seen in CMA.9 Learn more

4. What is a hypoallergenic formula?

Hypoallergenic infant formulas are those formulas that are tolerated by ≥90% of infants with documented CMA.10 Formulas that are proven to be hypoallergenic fall into two classes:

i. Extensively hydrolysed formula (eHF), e.g. Nutramigen LIPIL

  • Recommended for most infants with mild-to-moderate CMA3,5
  • Protein content has been extensively hydrolysed (broken down) into small peptides and amino acids, which are unlikely to trigger an allergic reaction in most infants

ii. Amino acid-based formula (AAF), e.g. Nutramigen PURAMINO

  • Recommended for infants with severe CMA and multiple food allergies or when an eHF is ineffective3,4
  • Based on 100% non-allergenic free amino acids


5. How do hypoallergenic formulas compare in terms of cost effectiveness for newly diagnosed infants with CMA?

A study compared healthcare resource use in two matched cohorts of infants with CMA, who were initially prescribed either Nutramigen LIPIL (eHF) or Neocate® (AAF).11 The investigators found that initiating therapy with Nutramigen LIPIL resulted in 41% lower healthcare costs over the first 12 months, compared to initiating with Neocate®.11
There were no significant differences in clinical outcomes between the two groups.11 Therefore, an eHF such as Nutramigen is the cost effective option compared to an AAF such as Neocate® in this patient group.11 Initiating treatment with Nutramigen LIPIL also aligns with expert guidelines, which recommend that most infants with mild-to-moderate CMA should receive an eHF as first-line.3,5 Learn more
Using Nutramigen LIPIL first-line can reduce costs by 41% (£1,300) per CMA patient in the first year (2008/9 prices).11


Prices per 400g tin: Nutramigen LIPIL – £10.11; Neocate® LCP – £26.22 (MIMS, August 2012)

6. Should soya formula, comfort formula, lactose-free formula or milk from other animals be used for CMA?

Only extensively hydrolysed fomulas (eHFs) and amino acid-based formulas (AAFs) are considered hypoallergenic and therefore suitable for management of CMA.3,4
Soya formula should not be given to infants before 6 months of age, and it should not be the first choice for older infants.3,4 Milk from animals like sheep and goats contain unmodified proteins that may trigger a reaction in infants with CMA.3–5 Lactose-free formulas contain whole cow’s milk protein, while ‘comfort’ formulas contain milk protein that is only partially hydrolysed (broken down). As a result, none of these feeds have been shown to meet the criterion for hypoallergenicity; therefore they are unsuitable for infants with CMA.3–5 Learn more


Common questions from parents

1. What is the difference between Nutramigen LIPIL 1 and Nutramigen LIPIL 2?

Nutramigen LIPIL 1 & 2 are both extensively hydrolysed formulas suitable for diagnostic elimination diets and the management of CMA. The difference is that Nutramigen LIPIL 1 is suitable from birth to 6 months, while Nutramigen LIPIL 2 is tailored to meet nutritional needs from 6 months, with more calcium and other nutrients to complement a weaning diet. Switching from Nutramigen LIPIL 1 to Nutramigen LIPIL 2 at 6 months can help ensure that the child continues receiving the required levels of key nutrients throughout weaning and beyond.

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2. Hypoallergenic formula tastes different from routine formula; how can I get my baby started on Nutramigen LIPIL or Nutramigen PURAMINO?

Due to their special formulation, hypoallergenic formulas taste similar to one another, but different from routine formulas. Nonetheless, scientific studies have shown that young infants adapt quickly to the taste (and do not dislike it).12 After switching to Nutramigen, it might take up to a week for a baby to get used to the new taste.
Tips for getting started:
  • For babies who are receiving breast milk, it may help to initially introduce Nutramigen in a 1:1 mix with breast milk, before gradually increasing the proportion in subsequent feeds.order-patient-booklets-2.png
  • Ideally, the baby should switch from their routine formula to Nutramigen as soon as possible after diagnosis.
  • It helps to wait until the baby is hungry and thirsty before trying the formula for the first time.
  • Parents should try to be positive during feeding times, as babies can pick up on their reactions. 
  • Older children may prefer to take the formula from a covered cup or as a cold drink.
  • For babies who are weaning, Nutramigen may be incorporated into foods and used in recipes, which may help the baby to get used to the formula.


3. Can I give my baby off-the-shelf milks such as oat and rice drinks?

Off-the-shelf milks are generally not suitable for young children with CMA.

  • Milks made from oat, soy, quinoa, sesame, almond or coconut do not provide adequate nutrition, and should not be used as a main source of nutrition until an infant is at least 2 years old.3
  • Rice drinks are only suitable for children over 4½ years of age.12
  • Milk from other animals, such as sheep or goats, contains similar protein to cow’s milk and is not recommended for children with CMA.3

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

  2. 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.

  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. 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.

  5. 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.

  6. Koletzko S, Niggemann B, Friedrichs F, Koletzko B. Vorgehen bei Sauglingen mit Verdacht auf Kuhmilchproteinallergie. Monatsschrift Kinderheilkunde 2009;157:687-91.

  7. Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: a double-blind study. Pediatrics 1982;70:7-10.

  8. National Institute for Health and Clinical Excellence. CG37: Postnatal care. 2006.

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

  10. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000;106:346-9.

  11. Taylor RR, Sladkevicius E, Panca M et al. Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK. Pediatr Allergy Immunol 2012;23:240-9.

  12. Beauchamp GK, Mennella JA. Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr 2009;48 Suppl 1:S25-S30.

  13. Food Standards Agency. Food Survey Information Sheet 02/09. 2009.