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Understanding cow’s milk allergy (CMA)

Your guide to recognising and managing CMA.

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

Dermatological (e.g. rash, eczema, itching, swelling)
Respiratory (e.g. sneezing or itching, blocked/runny nose)
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