- This guideline is for infants with Non-IgE mediated reactions to cow’s milk.
- This guideline is not appropriate to treat infants showing severe or immediate reactions to cow’s milk.
The prevalence of milk allergy is increasing and as a result infants are increasingly referred to Dietetic services for advice regarding the avoidance of milk and supplementation with an appropriate alternative formula. On presentation an allergy focused history (Table 3) and presenting symptoms can usually determine if the allergy is an IgE or Non-IgE mediated reaction and this will also determine the appropriate treatment course.
IgE reactions can be severe and (rarely) lead to anaphylaxis therefore the diagnostic techniques of exclusion and reintroduction, where this may induce a severe reaction, are not recommended. IgE allergy should be confirmed by Specific IgE or Skin Prick Test investigations. Repeat monitoring of these investigations should guide appropriate timing for reintroduction. In some cases, where symptoms pose significant risk, reintroduction attempts will require to be carried out in the hospital setting.
Non-IgE mediated allergy cannot be confirmed using the above investigation techniques, therefore diagnosis is confirmed by symptom response to a period of exclusion followed by challenge with cow’s milk. Many Non-IgE milk allergy symptoms are common in infancy and challenge with milk is required to ensure that infants are not following an exclusion diet unnecessarily.
There are several alternative infant formula which have Advisory Committee of Borderline Substances (ACBS) for the treatment of cow’s milk allergy. There is a significant cost difference between Extensively Hydrolysed Formulas (eHFs) and Amino Acid Formulas (AAFs), ensuring appropriate prescription has potential for significant cost savings.
There is evidence to suggest that prolonged avoidance of milk can impact children nutritionally and socially and may lead to long termrestrictive eatingtherefore regular monitoring and timely staged reintroduction of cow’s milk is essential.
The aims of this guideline are:
- To standardise the diagnosis and management of Non-IgE mediated cow’s milk protein allergy (CMPA)
- To help staff including GPs, health visitors, paediatricians and A&E staff initiate the management of symptomatic cow’s milk protein allergy.
- To ensure the most appropriate and cost effective alternative formula are prescribed
- To ensure children are not following an exclusion diet for longer than necessary.