HCP

Key facts about cows' milk allergy (CMA)

FOOD ALLERGY OR NON-ALLERGIC FOOD HYPERSENSITIVITY
COWS' MILK ALLERGY
LACTOSE INTOLERANCE
IMPORTANCE OF LACTOSE FOR GUT MICROBIOTA
INCIDENCE AND PREVALENCE OF CMA

Signs & Symptoms of cows' milk allergy

The non-specific signs and symptoms of CMA, ranging from colic and reflux to constipation, insomnia, eczema, diarrhoea and crying, make diagnosis a real challenge. The symptoms involve many different organ systems, predominantly the skin and the gastrointestinal and respiratory tracts. The involvement of two or more organ systems increases the likelihood of CMA.

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Digestive

Prevalence of digestive symptoms

Up to 60% of affected infants have digestive symptoms.7

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Respiratory

Prevalence of respiratory symptoms

Up to 30% of affected infants have respiratory symptoms.7

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Skin

Prevalence of skin-related symptoms

Up to 70% of affected infants have skin-related symptoms.7

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General

Inconsolable crying is common in infants with CMA, while anaphylaxis is rare.


Diagnosis of CMA should always be made by a healthcare professional


REFERENCES

  1. NICE. Food allergy in under 19s: assessment and diagnosis. CG116. 2011.
  2. NHS Choices. Food Allergy.2016 Available at: https://www.nhs.uk/conditions/food-allergy/ (Accessed November 2017).
  3. US FDA. Food Allergies: What You Need to Know. Available at: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm079311.htm (accessed Jan 2017).
  4. Koletzko S et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN Gl Committee Practical Guidelines. JPGN. 2012;55:221–9.
  5. Heyman MB et al. Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118(3):1279–86.
  6. Martin C et al. Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients 2016, 8, 279;
  7. Høst & Halken. Cow’s Milk Allergy: Where have we Come from and where are we Going? Endocrine, Metabolic & Immune Disorders - Drug Targets, 2014:14:2-8.
  8. NIH. Lactose intolerance. Available at: https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics (accessed February 2017).
  9. Francavilla R et al. Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy. Pediatr Allergy Immunol. 2012;23(5):420–7.
  10. Luyt D et al. BSACI Milk allergy guideline. Clinical & Experimental Allergy, 2014 (44) 642–672.
  11. Venter C et al. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy – a UK primary care practical guide. Clinical and Translational Allergy. 2013;3(1):23
  12. Koletzko S, et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN Gl Committee Practical Guidelines. JPGN. 2012;55:221–9.
  13. Lifschitz C & Szajewskav H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015;174(2):141–50;2.
  14. Høst A & Halken S. Cow's milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets. 2014;14(1):2–8.
  15. Abrams S. et al. Calcium and zinc absorption from lactose-containing and lactose free infant formulas. Am J Clin Nutr, 2002; 76:442–6.

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cows' milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows' milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.