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Diagnosis and management of cow's milk protein allergy in infants

What's New

21/12/2020 Addition of section on allergy focused history; updated signs & symptoms; pathway updated & emphasis on supporting continuation of breastfeeding


This guideline is intended for use by all health professionals in the acute and primary care settings for the diagnosis and management of infants and young children (up to two years) with symptoms of suspected cow’s milk protein allergy (CMPA).

The following steps should be followed:

  • Undertake an allergy focused clinical history
  • Refer to the signs and symptoms guide to determine the diagnosis
  • Follow the appropriate pathway for IgE and non IgE mediated CMPA
  • Refer to the NHSGGC Formulary, Hypoallergenic formula for  the management of cow’s milk allergy in Children, for guidance on  the appropriate formula
  1. Agostoni C, Axelsson I, Goulet O. Medical Position Paper: Soy Protein Infant Formulae and Follow On Formulae: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2006;42:352-361.
  1. Du Toit G., Meyer R, Shah N et al. Identifying and Managing cows’ milk protein allergy Arch Dis Child Educ Pract Ed 2010;95:134-144
  1. Fiocchi A, Brozek J et al. World Allergy Organisation (WAO) Diagnosis and rationale for action against cows milk allergy (DRACMA) guidelines. Pedatr Allergy Immunol 2010;21;1-125
  1. Koletzko S, Niggemann B, Arato A et al. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee Practical Guidelines. JPGN;55;2;August 2012.
  1. Ludman S, Shah N, Fox AT. Managing cows’ milk allergy in children. BMJ 2013;347:f5424
  1. Luyt D, Ball H, Makwana N et al. BSACI guidelines for the diagnosis and management of cow’s milk allergy. Clinical & Experimental Allergy 2014 44, 642-672
  1. National Institute for Health and Clinical Excellence (NICE): Food allergy in children and young people. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. Clinical guideline 116. February 2011. NICE. London.
  1. Venter C, Brown T, Shah N et al. Diagnosis and management of non-IgE-medicated cow’s milk allergy in infancy – a UK primary care practical guide. Clinical and Translational Allergy 2013;3:23.
Editorial Information

Last reviewed: 01 December 2020

Next review: 31 December 2022

Author(s): Dr George Raptis, Paediatric Allergy Consultant; Anne Maclean, Dietetics Manager Paediatrics; David Inglis, Digital Health Practice Development Dietitian

Approved By: Area Drug and Therapeutic Committee