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Understanding cow’s milk allergy (CMA)

Your guide to recognising and managing CMA.

Healthcare professional smiling while holding a baby in a clinic corridor

Early detection is vital for effective allergy management

  • CMA is the most common food allergy in infants and symptoms often overlap with common infancy conditions1
    - CMA is often mistaken for lactose intolerance1
  • Early and accurate diagnosis is key to reducing future allergic manifestations2

Symptoms of CMA

Hexagonal icon depicting dermatological symptoms of cow's milk allergy
Dermatological (e.g. rash, eczema, itching, swelling)
Hexagonal icon depicting respiratory symptoms of cow's milk allergy
Respiratory (e.g. sneezing or itching, blocked/runny nose)
Hexagonal icon depicting gastrointestinal symptoms of cow's milk allergy
Gastrointestinal (e.g. regurgitation, vomiting, abdominal pain, diarrhoea or constipation)

Systematic approach for effective care3

IgE-mediated allergy3Non-IgE-mediated allergy3
Assess symptoms with an allergy focused historyAssess symptoms with an allergy focused history
Elimination dietElimination diet (2-4 weeks to confirm diagnosis)
Allergy testingActive reintroduction
Active reintroduction 

 

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IMPORTANT NOTICE:

Breastfeeding is best for babies and the nutritional benefits of breastfeeding should be carefully considered before bottle-feeding is initiated. The decision to discontinue breastfeeding may be difficult to reverse and the introduction of partial bottle-feeding may reduce breast milk supply. However, we recognise that breastfeeding may not be an option for every mother. Where a formula for special medical purposes is required, parents should only use this after consulting a healthcare professional. Preparation should follow label instructions; failure to do so may be harmful to the health of the child.

  1. Lozinsky AC et al. Children. 2015;2:317-329.
  2. Vandenplas Y et al. Arch Dis Child. 2007;92:902-908.
  3. Fox A, Lovis MT. The GP Infant Feeding Network (UK). The Milk allergy in primary care guideline 2019. October 2019. https://gpifn.org.uk/imap/. Accessed October 2025.
  4. Hemarajata P, Versalovic J. Ther Adv Gastroenterol. 2013;6:39-51.
  5. Guest JF, Fuller GW. J Comp Eff Res. 2019;8:449-459.
  6. Nocerino R et al. J Pediatr. 2021;232:183-191.
  7. Gao J et al. Front Microbiol. 2019;10:477.
  8. Isolauri E et al. Gastroenterology. 1993;105:1643-1650.
  9. BSACI's Paediatric Allergy Group (PAG), Food Allergy Specialist Group (FASG). Early Feeding Guidance for HCP's. May 2018.
  10. Bognanni A et al. World Allergy Organ J. 2024;17:100888.
  11. Vandenplas Y et al. J Pediatr Gastroenterol Nutr. 2024;78:386-413.
  12. Rosa D et al. Front Pediatr. 2024;11:1283389.
  13. Salvatore S et al. Acta Paediatricia. 2018;107:1512-1520.

Abbreviations

CMA, cows milk allergy; DGBI, disorders of the gut-brain interaction; ESPGHAN, European Society for Paediatric Gastroenterology Hepatology and Nutrition;
Ig, immunoglobulin.

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RKT-M-75468 October 2025