Cow’s Milk Allergy (CMA)

nutritionCow’s Milk Allergy (CMA) is an immune response to cow’s milk protein. CMA can present with a variety of symptoms generally affecting the respiratory tract (e.g. sneezing, wheezing), the skin (e.g. skin rash, eczema) and the gastrointestinal tract (e.g. vomiting, diarrhoea, constipation) [2].


Dietary management CMA

Infants with confirmed cow’s milk allergy should be treated by complete exclusion of cow’s milk protein (CMP) [6].

Exclusively breastfed infants

As in healthy infants, breast feeding should be encouraged. However, very rarely, exclusively breast-fed babies can react to cow’s milk proteins present in breast milk. Infants can be exposed to these proteins in breast milk following maternal consumption of dairy products[3]. Therefore in the exclusively breast fed infant an elimination diet of the lactating mother should be tried[6].


Formula fed infants

In formula fed CMA infants cow’s milk derived infant formula should be avoided, including soy formulae which are not recommended before the age of six months[6]. ESPGHAN recommends that, hypoallergenic formula including extensively hydrolysed formula (eHF) and amino acid based formula (AAF) should be the formula of choice. The choice between extensively hydrolysed formulae (eHF) and amino acid based formulae (AAF) depends on the type of allergy and the severity of symptoms [5, 6].

[1] Wood R. The Natural History of Food Allergy.Pediatrics2003;111;1631-1637
[2] Fiocchi A et al. World AllergyOrganization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines.WAO Journal April 2010;57-161
[3] Du Toit G; Meyer R; Shah N; Heine RG; Thomson MA; Lack G; Fox A Identifying and managing cow’s milk protein allergy Arch Dis Child Educ Pract Ed 2010
[4] Skypala I. and Venter C. Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerance 1st edition Wiley&Blackwell 2009
[5] Hill DJ et al. The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: a systematic review. Clin Exp Allergy 2007; 37, 808-822.